Abstract
Objective: To evaluate the association of serum malondialdehyde low-density lipoprotein (MDA-LDL), an oxidatively modified LDL, with the prevalence of high-risk plaques (HRP) determined with coronary computed tomography angiography (CTA) in statin-treated patients. Methods: This study was a single-center retrospective cohort comprising 268 patients (mean age 67 years, 58% men) with statin therapy and who underwent coronary CTA for suspected stable coronary artery disease. Patients were classified into two groups according to median MDA-LDL level or median LDL-C level. Coronary CTA-verified HRP was defined when two or more characteristics, including positive remodeling, low-density plaques, and spotty calcification, were present. Results: Patients with HRP had higher MDA-LDL (p = 0.011), but not LDL-C (p = 0.867) than those without HRP. High MDA-LDL was independently associated with HRP (odds ratio 1.883, 95% confidential interval 1.082–3.279) after adjustment for traditional risk factors. Regarding incremental value of MDA-LDL for predicting CTA-verified HRP, addition of serum MDA-LDL levels to the baseline model significantly increased global chi-square score from 26.1 to 32.8 (p = 0.010). Conclusions: A high serum MDA-LDL level is an independent predictor of CTA-verified HRP, which can lead to cardiovascular events in statin-treated patients.
Highlights
Cardiovascular disease is the leading global cause of adult mortality and morbidity [1]
The aim of this study was to clarify the association between serum malondialdehyde lowdensity lipoprotein (MDA-low-density lipoprotein (LDL)) levels and the prevalence of high-risk plaques (HRP), which increases the likelihood of acute coronary events in patients with suspected stable coronary artery disease receiving statin therapy
This study demonstrated that serum MDA-LDL, but not lowdensity lipoprotein cholesterol (LDL-C), was significantly associated with the presence of HRP and had a moderate incremental value to predict HRP
Summary
Cardiovascular disease is the leading global cause of adult mortality and morbidity [1]. Many studies have demonstrated a beneficial effect of low-density lipoprotein (LDL)-lowering therapies by statins on cardiovascular outcomes [2,3]. Lowering lowdensity lipoprotein cholesterol (LDL-C) is the primary target in cardiovascular disease prevention; despite effective LDL-lowering treatment, substantial patients remain at cardiovascular risk [4]. Serum malondialdehyde lowdensity lipoprotein (MDA-LDL), which is an oxidatively modified LDL, has been reported to be associated with coronary plaque vulnerability [5], adverse clinical outcomes after percutaneous coronary intervention [6], and the incidence of acute coronary syndrome [7]. The clinical relevance of serum MDA-LDL levels in patients receiving statin therapy for cardiovascular events has not been fully elucidated. Many observational follow-up studies have demonstrated the association between high-risk plaques (HRP) by coronary CTA and cardiovascular events [9,10]. Statins contribute to the stabilization of plaques [11], HRP is often detected by coronary CTA even in patients receiving statin therapy
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