Letter to the Editor
Coronary risk factors and coronary atheroma burden at severely narrowing segments

https://doi.org/10.1016/j.ijcard.2006.11.194Get rights and content

Abstract

Background

While only few data exist correlating cardiovascular risk factors with volumetric measurements of coronary atheroma burden in patients with coronary artery disease, a recent report using intravascular ultrasound (IVUS) demonstrated independent predictors of atherosclerotic burden in a native coronary artery with relatively mild narrowing (20–50% diameter stenosis by visual estimation). The purpose of this study was to examine whether cardiovascular risk factors can predict atherosclerotic burden at severely narrowing segments (> 50% diameter stenosis).

Methods

Patients who met the criteria (high-quality, automated pull-back IVUS images of severely narrowing segments prior to intervention) were identified from the IVUS database of the Cardiovascular Core Analysis Laboratory at Stanford University. Using commercially available planimetry software, lumen and vessel inside external elastic membrane areas were manually traced at every 0.5-mm interval in diseased segments. Using Simpson's method, vessel, lumen, and plaque (vessel minus lumen) volumes were calculated, and average area was calculated as volume data divided by length. Percent plaque volume was computed as plaque volume divided by vessel volume. Multiple linear regression analysis with backward selection was used to determine the risk factors for atherosclerotic burden.

Results

For percent plaque volume, diabetes or hypertension were predictors of more severe disease. For average plaque area, male gender or diabetes were predictors of more severe disease. These variables were also independent predictors in multivariate regression models.

Conclusions

Male gender, hypertension, and diabetes are also strong independent predictors of atherosclerotic burden in coronary disease patients, though analyzed segments and disease severity were different.

Introduction

A recent report using 3-dimensional intravascular ultrasound (IVUS) demonstrated that some established cardiovascular risk factors (male gender, hypertension and diabetes) are independent predictors of atherosclerotic burden in a native coronary artery with relatively mild angiographic narrowing (20–50% diameter stenosis (DS) by visual estimation) [1]. However, whether established cardiovascular risk factors can predict volumetric measurements of coronary atheroma burden at severely narrowing segments (> 50% DS) remains unknown.

Section snippets

Materials and methods

Patients who met the following criteria were identified from the IVUS database of the Cardiovascular Core Analysis Laboratory at Stanford University (Stanford, California): high-quality, automated pull-back IVUS images of severely narrowing segments (> 50% DS) prior to intervention. Data on cardiovascular risk factors were collected. All cineangiograms were analyzed at a central core laboratory using standardized criteria. The protocol was approved by the institutional review board, and written

Results

A total of 250 patients were enrolled in the study. Patient demographics, lesion characteristics, and IVUS variables are summarized in Table 1, Table 2, Table 3. Univariate and multivariate predictors of IVUS disease burden are summarized in Table 4. For percent plaque volume, diabetes or hypertension were predictors of more severe disease. For average plaque area, male gender or diabetes were predictors of more severe disease. These variables were also independent predictors in multivariate

Discussion

Compared to a previous report, [1] patients have more disease burden in this study (percent plaque volume, 69.3% vs. 38.9%). Although this study included older patients, more males, more smokers, more patients with diabetes, but fewer patients with hypertension or dyslipidemia, the difference may come mainly from differences of analyzed segments. Due to the study design (paired analysis between baseline and 18 month follow-up), the previous report analyzed segments with relatively mild stenosis

Acknowledgment

The authors thank Heidi N. Bonneau, RN, MS for her expert review of the manuscript.

References (10)

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