Abstract：
Low-density lipoprotein cholesterol (LDL-C) levels are recommended according to the patient\'s risk factors based on guidelines. In patients achieving low LDL-C levels, the need for statins is uncertain, and the plaque characteristics of patients not treated with statins are unclear. In addition, the difference in plaque characteristics with and without statins is unclear in similarly high LDL levels. We evaluate the impact of statins on plaque characteristics on optical coherence tomography (OCT) in patients with very low LDL-C levels and high LDL-C levels. A total of 173 stable angina pectoris patients with 173 lesions undergoing OCT before percutaneous coronary intervention were evaluated. We divided the LDL-C levels into three groups: < 70 mg/dL (n = 48), 70 mg/dL ≤ LDL-C < 100 mg/dL (n = 71), and ≥ 100 mg/dL (n = 54). Among patients with LDL-C < 70 mg/dL, patients not treated with statins showed a significantly higher C-reactive protein level (0.27 ± 0.22 mg/dL vs. 0.15 ± 0.19 mg/dL, p = 0.049), and higher incidence of thin-cap fibroatheromas (TCFAs; 44% [7/16] vs. 13% [4/32], p = 0.021) than those treated with statins. Among patients with LDL-C level ≥ 100 mg/dL, patients treated with statins showed a significantly higher prevalence of familial hypercholesterolemia (FH) (38% [6/16] vs. 5% [2/38], p = 0.004), lower incidence of TCFAs (6% [1/16] vs. 39% [15/38], p = 0.013), healed plaques (13% [2/16] vs. 47% [18/38], p = 0.015), and higher incidence of fibrous plaques (75% [12/16] vs. 42% [16/38], p = 0.027) than patients not treated with statins. While patients achieved a low LDL-C, patients not treated with statins had high plaque vulnerability and high systemic inflammation. While patients had a high LDL-C level with a high prevalence of FH, patients treated with statins had stable plaque characteristics.
摘要：
低密度脂蛋白胆固醇（LDL-C）水平根据患者的危险因素推荐。在达到低LDL-C水平的患者中，他汀类药物的需求是不确定的，未接受他汀类药物治疗的患者的斑块特征尚不清楚.此外,在同样高的LDL水平下,有无他汀类药物的斑块特征差异尚不清楚.我们评估了他汀类药物对LDL-C水平非常低和LDL-C水平高的患者光学相干断层扫描（OCT）斑块特征的影响。总共评估了173例稳定型心绞痛患者，其中173例病变在经皮冠状动脉介入术之前接受了OCT。我们将LDL-C水平分为三组：<70mg/dL（n=48），70mg/dL≤LDL-C<100mg/dL（n=71），≥100mg/dL（n=54）。在LDL-C<70mg/dL的患者中，未接受他汀类药物治疗的患者的C反应蛋白水平显着升高（0.27±0.22mg/dL与0.15±0.19mg/dL，p=0.049),薄帽纤维粥样瘤的发病率较高（TCFAs；44%[7/16]vs.13%[4/32]，p=0.021）比他汀类药物治疗的那些。在LDL-C水平≥100mg/dL的患者中，使用他汀类药物治疗的患者显示家族性高胆固醇血症（FH）的患病率明显更高（38％[6/16]与5%[2/38]，p=0.004),TCFAs发生率较低(6%[1/16]与39%[15/38]，p=0.013),愈合斑块（13%[2/16]vs.47%[18/38]，p=0.015),纤维斑块的发生率较高（75%[12/16]与42%[16/38]，p=0.027）比未使用他汀类药物治疗的患者。虽然患者获得了低LDL-C，未接受他汀类药物治疗的患者有较高的斑块易损性和较高的全身性炎症.虽然患者的LDL-C水平较高，FH患病率较高，他汀类药物治疗的患者具有稳定的斑块特征.
