| Clinical predictors of plaque progression despite very low levels of low-density lipoprotein cholesterol. | |
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MedLine Citation:
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PMID: 20538166 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: The purpose of this study was to characterize the determinants of plaque progression despite achieving very low levels of low-density lipoprotein cholesterol (LDL-C). BACKGROUND: Despite achieving very low levels of LDL-C, many patients continue to demonstrate disease progression and have clinical events. METHODS: A total of 3,437 patients with coronary artery disease underwent serial intravascular ultrasound examination in 7 clinical trials. Patients who achieved an on-treatment LDL-C level of <or=70 mg/dl (n = 951) were stratified as progressors (n = 200) and nonprogressors (n = 751) and compared. RESULTS: Despite achieving LDL-C <or=70 mg/dl, >20% of patients continued to progress. There were no demographic differences between groups. Progressors demonstrated higher baseline levels of glucose (117.1 +/- 42.5 mg/dl vs. 112.1 +/- 40.0 mg/dl, p = 0.02), triglycerides (157.5 mg/dl vs. 133.0 mg/dl, p = 0.004), and a smaller decrease of apolipoprotein B (-25.1 +/- 3.4 mg/dl vs. -27.4 +/- 3.35 mg/dl, p = 0.01) at follow-up. Multivariable analysis revealed that independently associated risk factors of progression in patients with LDL-C <or=70 mg/dl included baseline percent atheroma volume (p = 0.001), presence of diabetes mellitus (p = 0.02), increase in systolic blood pressure (p = 0.001), less increase in high-density lipoprotein cholesterol (p = 0.01), and a smaller decrease in apolipoprotein B levels (p = 0.001), but not changes in C-reactive protein (p = 0.78) or LDL-C (p = 0.84). CONCLUSIONS: Residual risk factors are associated with the likelihood of disease progression in patients who achieve very low LDL-C levels. In addition, the association between apolipoprotein B and atheroma progression highlights the potential importance of LDL particle concentration in patients with optimal LDL-C control. This finding highlights the need for intensive modification of global risk in patients with coronary artery disease. |
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Authors:
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Ozgur Bayturan; Samir Kapadia; Stephen J Nicholls; E Murat Tuzcu; Mingyuan Shao; Kiyoko Uno; Ajai Shreevatsa; Andrea J Lavoie; Kathy Wolski; Paul Schoenhagen; Steven E Nissen |
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Publication Detail:
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Type: Clinical Trial; Comparative Study; Journal Article |
Journal Detail:
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Title: Journal of the American College of Cardiology Volume: 55 ISSN: 1558-3597 ISO Abbreviation: J. Am. Coll. Cardiol. Publication Date: 2010 Jun |
Date Detail:
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Created Date: 2010-06-11 Completed Date: 2010-07-06 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8301365 Medline TA: J Am Coll Cardiol Country: United States |
Other Details:
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Languages: eng Pagination: 2736-42 Citation Subset: AIM; IM |
Copyright Information:
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Copyright (c) 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. |
Affiliation:
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Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio 44195, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Atherosclerosis
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blood,
ultrasonography* Cholesterol, LDL / blood* Coronary Disease / blood, ultrasonography* Coronary Vessels / ultrasonography* Disease Progression Female Follow-Up Studies Humans Male Middle Aged Predictive Value of Tests Prospective Studies Risk Factors Ultrasonography, Interventional / methods* |
| Chemical | |
Reg. No./Substance:
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0/Cholesterol, LDL |
| Comments/Corrections | |
Comment In:
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J Am Coll Cardiol. 2010 Jun 15;55(24):2743-4
[PMID:
20538167
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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