Association between low-density lipoprotein cholesterol and coronary plaque progression in non-dialysis chronic kidney disease: a retrospective cohort study

This study aimed to investigate the characteristics of coronary plaque progression in non-dialysis chronic kidney disease (CKD) patients, particularly focusing on the association between low-density lipoprotein cholesterol (LDL-C) levels and plaque progression across different stages of CKD. Two hundred ninety-two patients with CKD who underwent percutaneous coronary intervention during their initial coronary angiography and received follow-up angiography within 2 years were enrolled. These patients were classified into plaque progression and non-progression groups using quantitative coronary angiography analysis. Our findings demonstrate that patients with coronary plaque progression exhibited higher LDL-C levels and lower estimated glomerular filtration rate (eGFR). Smooth curve and logistic regression analysis revealed a gradual increase in the probability of plaque progression with elevated LDL-C levels, each 1 mmol/L increase in LDL-C was associated with a 2.63-fold higher risk of plaque progression in patients with eGFR of 45-60 mL/min/1.73 m² (OR = 3.63, 95% CI: 1.65-8.01), and 2.44-fold increased risk in patients with eGFR <45 mL/min/1.73 m² (OR = 3.44, 95% CI: 1.23-9.61). Kaplan-Meier curve and multivariate regression analysis demonstrated that maintaining LDL-C levels below the guideline-recommended very-high-risk threshold (1.4 mmol/L) conferred persistent protective effects against coronary plaque progression in CKD patients. This study demonstrated a graded association between LDL-C levels and coronary plaque progression in non-dialysis CKD patients, and this association was significantly weaker in the subgroup with lower eGFR compared to that with higher eGFR. Moreover, our findings suggest an association between lower LDL-C levels and reduced risk of coronary plaque progression in this high-risk population.