In patients with ACS, an increasing number of cardiovascular risk factors was strongly associated with greater plaque vulnerability in culprit lesions, including thin-cap fibroatheromas (P trend=0.006).
Observational
Does a higher cumulative number of traditional cardiovascular risk factors increase OCT-defined plaque vulnerability in patients with acute coronary syndrome?
An increasing burden of traditional cardiovascular risk factors is strongly associated with greater OCT-defined plaque vulnerability, particularly in culprit lesions of patients with ACS.
BACKGROUND Cardiovascular risk factors are strongly associated with adverse clinical outcomes, including acute coronary syndrome (ACS). Although individual risk factors have been related to specific plaque phenotypes, the relationship between the cumulative number of risk factors and plaque vulnerability has not been systematically explored. OBJECTIVES The purpose of this study was to investigate the association between the number of cardiovascular risk factors and plaque vulnerability defined by optical coherence tomography. METHODS Patients with ACS were divided into 5 groups based on their number of traditional risk factors (diabetes, hypertension, hyperlipidemia, smoking) or into 2 groups (0-1 vs ≥2 risk factors). Features of vulnerability in both culprit and nonculprit lesions were analyzed. RESULTS Of 2,187 plaques analyzed, 1,581 were culprit and 606 nonculprit plaques. In culprit plaques, the prevalence of lipid-rich plaques (P trend = 0.027), thin-cap fibroatheromas (P trend = 0.006), macrophages (P trend <0.001), microvessels (P trend <0.001), and cholesterol crystals (P trend = 0.032) increased as the number of risk factors increased. The presence of ≥2 risk factors was independently associated with all vulnerable features except lipid-rich plaques. Plaque rupture showed an increasing prevalence as the number of risk factors increased (P trend = 0.015), whereas plaque erosion showed a decreasing trend (P trend <0.001). In nonculprit plaques, only macrophages, cholesterol crystals, and the cumulative number of vulnerable features in each plaque exhibited a significant positive association with the number of risk factors. CONCLUSIONS In patients with ACS, an increasing number of cardiovascular risk factors were strongly associated with greater plaque vulnerability, especially for culprit lesions. These findings may explain the relationship between traditional risk factors and adverse clinical outcomes.
“We know patients with multiple risk factors are at higher risk for future adverse events [like CV death and MI], so everybody assumed the mechanism is related to vascular instability or vulnerability. But nobody really has tried to bridge this gap [before].”
Covani et al. (Tue,) conducted a observational in Acute Coronary Syndrome. Cumulative number of cardiovascular risk factors vs. 0-1 risk factors was evaluated on Plaque vulnerability features in culprit and nonculprit lesions defined by optical coherence tomography. In patients with ACS, an increasing number of cardiovascular risk factors was strongly associated with greater plaque vulnerability in culprit lesions, including thin-cap fibroatheromas (P trend=0.006).