Key result
Higher ox-LDL linked to more vulnerable plaque features exclusively in patients with diabetes.
Why the study?
Are higher levels of oxidized LDL associated with increased coronary plaque vulnerability in patients with diabetes mellitus?
Cohort (n=138)
No
Are higher levels of oxidized LDL associated with increased coronary plaque vulnerability in patients with diabetes mellitus?
p-value: p=0.040 for lipid index trend; 0.009 for macrophage grade trend in DM
Oxidized LDL levels are associated with increased coronary plaque vulnerability, as assessed by OCT, specifically in patients with diabetes mellitus.
Background The oxidation of low-density lipoprotein cholesterol (LDL-C) is critical in plaque inflammation and the subsequent vulnerable plaque formation. The inflammatory response to oxidized LDL (ox-LDL) is reportedly exacerbated under high glucose conditions. However, the relationship between ox-LDL and coronary plaque morphology in patients with diabetes mellitus (DM) has not been systematically studied. Purpose To investigate the association between ox-LDL and plaque morphology assessed by optical coherence tomography (OCT). Methods This was an observational, single-center cohort study. A total of 138 patients with chronic coronary syndrome who underwent OCT were analyzed. Malondialdehyde-modified LDL (MDA-LDL), a representative form of ox-LDL, was measured. Levels of ox-LDL were assessed using the ratio of MDA-LDL to LDL-C. Plaques at target lesions were imaged by OCT. The lipid index was calculated as the product of the mean lipid arc and length. The macrophage accumulation was graded at 1-mm intervals along the entire target plaques (0: no accumulation, 1: focal spotty, 2: clustered < 1 quadrant, 3: ≥ 1 and < 3 quadrants, and 4: ≥ 3 quadrants) and summed (macrophage grade). Results Patients were divided into three groups according to the tertiles of ox-LDL levels. Lipid index and macrophage grade were significantly higher in patients with higher levels of ox-LDL in patients with DM (low vs. moderate vs. high; lipid index: 714 vs. 1226 vs. 2217, p for trend = 0.040; macrophage grade: 2 vs. 7 vs. 13, p for trend = 0.009; Panel A)(Figure). In contrast, no association was found in non-DM patients (low vs. moderate vs. high; lipid index: 1109 vs. 1181 vs. 1436, p for trend = 0.633; macrophage grade: 8 vs. 5 vs. 8, p for trend = 0.748; Panel B). The levels of ox-LDL had a significant positive correlation with lipid index and macrophage grade after adjustment for confounders in patients with DM, but not in those without. Conclusions The ox-LDL levels were associated with plaque vulnerability only in DM patients.
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Goto et al. (2025) conducted a cohort in chronic coronary syndrome (n=138). Oxidized low-density lipoprotein cholesterol (ox-LDL) vs. Lower tertiles of ox-LDL was evaluated on Lipid index and macrophage grade assessed by OCT (p=0.040 for lipid index trend; 0.009 for macrophage grade trend in DM). Higher ox-LDL levels were significantly associated with increased lipid index (p=0.040 for trend) and macrophage grade (p=0.009 for trend) in patients with diabetes mellitus, but not in those without.
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