PDF(Pubmed)
Abstract：
Background Residual risk of cardiovascular events and plaque progression remains despite reduction in low-density lipoprotein cholesterol. Factors contributing to residual risk remain unclear. The authors examined the role of eicosapentaenoic acid and docosahexaenoic acid in coronary plaque regression and its predictors. Methods and Results A total of 240 patients with stable coronary artery disease were randomized to eicosapentaenoic acid plus docosahexaenoic acid (3.36 g/d) or none for 30 months. Patients were stratified by regression or progression of coronary fatty plaque measured by coronary computed tomographic angiography. Cardiac events were ascertained. The mean±SD age was 63.0±7.7 years, mean low-density lipoprotein cholesterol level was <2.07 mmol/L, and median triglyceride level was <1.38 mmol/L. Regressors had a 14.9% reduction in triglycerides that correlated with fatty plaque regression (r=0.135; P=0.036). Compared with regressors, progressors had higher cardiac events (5% vs 22.3%, respectively; P<0.001) and a 2.89-fold increased risk of cardiac events (95% CI, 1.1-8.0; P=0.034). Baseline non-high-density lipoprotein cholesterol level <2.59 mmol/L (100 mg/dL) and systolic blood pressure <125 mm Hg were significant independent predictors of fatty plaque regression. Normotensive patients taking eicosapentaenoic acid plus docosahexaenoic acid had regression of noncalcified coronary plaque that correlated with triglyceride reduction (r=0.35; P=0.034) and a significant decrease in neutrophil/lymphocyte ratio. In contrast, hypertensive patients had no change in noncalcified coronary plaque or neutrophil/lymphocyte ratio. Conclusions Triglyceride reduction, systolic blood pressure <125 mm Hg, and non-high-density lipoprotein cholesterol <2.59 mmol/L were associated with coronary plaque regression and reduced cardiac events. Normotensive patients had greater benefit than hypertensive patients potentially due to lower levels of inflammation. Future studies should examine the role of inflammation in plaque regression. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01624727.
摘要：
背景：尽管低密度脂蛋白胆固醇降低，但心血管事件和斑块进展的残余风险仍然存在。导致残余风险的因素仍不清楚。作者研究了二十碳五烯酸和二十二碳六烯酸在冠状动脉斑块消退中的作用及其预测因素。方法和结果240例稳定型冠心病患者随机分为二十碳五烯酸加二十二碳六烯酸（3.36g/d）或无二十碳五烯酸，共30个月。通过冠状动脉计算机断层扫描血管造影术测量的冠状动脉脂肪斑块的回归或进展对患者进行分层。确定心脏事件。平均±SD年龄为63.0±7.7岁，平均低密度脂蛋白胆固醇水平<2.07mmol/L，甘油三酯水平中位数<1.38mmol/L与脂肪斑块消退相关的甘油三酯减少了14.9%(r=0.135;P=0.036)。与回归变量相比，进展者有较高的心脏事件（5％vs22.3％，分别为；P<0.001）和心脏事件风险增加2.89倍（95％CI，1.1-8.0；P=0.034）。基线非高密度脂蛋白胆固醇水平<2.59mmol/L（100mg/dL）和收缩压<125mmHg是脂肪斑块消退的重要独立预测因素。服用二十碳五烯酸加二十二碳六烯酸的正常血压患者的非钙化冠状动脉斑块消退，与甘油三酯降低相关（r=0.35；P=0.034）和中性粒细胞/淋巴细胞比率显着降低。相比之下,高血压患者的非钙化冠状动脉斑块或中性粒细胞/淋巴细胞比值无变化.结论甘油三酯减少，收缩压<125mmHg，非高密度脂蛋白胆固醇<2.59mmol/L与冠状动脉斑块消退和心脏事件减少相关。正常血压患者比高血压患者有更大的获益，这可能是由于炎症水平较低。未来的研究应该检查炎症在斑块消退中的作用。注册网址：https://www。clinicaltrials.gov；唯一标识符：NCT01624727。
