Synergy effects between cholesterol efflux capacity and CPAP on atherosclerotic coronary plaques in patients with sleep-disordered breathing; the ENTERPRISE-CEC trial.

BACKGROUND AND AIMS: The ENTERPRISE trial previously verified the effects of continuous positive airway pressure (CPAP) on coronary plaques in patients with sleep-disordered breathing (SDB) coexisting with coronary artery disease (CAD). Cholesterol efflux capacity (CEC) is closely related to SDB; thus, this study aimed to investigate the impact of CEC on atherosclerotic coronary plaques in patients with SDB coexisting with CAD.

METHODS

CEC data from 47 patients measured using the immobilized liposome-bound magnetic beads method and imaging data obtained using near-infrared spectroscopy and intravascular ultrasound at both baseline and one year follow-up were analyzed. Simple and multiple linear regression analyses revealed the factors influenced %change in CEC and %change in normalized total atheroma volume (TAVnormalized), respectively.

RESULTS

The mean patient age was 61 ± 8 years, and 96% of the patients were males. 22 patients received CPAP treatment during the follow-up period. The improvement in CEC was significantly associated with an increase in the %change in ApoA-I, a decrease in the absolute change in hs-CRP; however, CPAP treatment could not directly contribute to the improvement in CEC. In addition, a significant interaction of the CPAP treatment × %change in CEC for predicting the %change in TAVnormalized was observed, and the improvements in CEC synergistically contributed to plaque regression in patients with SDB who received CPAP treatment (p = 0.034).

CONCLUSIONS

This study revealed the synergy effect between CEC and CPAP treatment on coronary plaques in patients with SDB coexisting with CAD. In patients with SDB receiving CPAP treatment, the coronary plaque regression is expected due to improvement in CEC.

CLINICAL TRIAL REGISTRATION: This study was registered with the University Hospital Medical Information Network (UMIN) (UMIN ID: R000036293). https://upload.umin.ac.jp/cgi-open-bin/icdr_e/ctr_view.cgi?recptno=R000036293.