Journal of clinical lipidology · 2025
Circulating apolipoprotein B levels in statin-treated type 2 diabetic patients with coronary artery disease: Implications for coronary atheroma progression and instability.
СтатьяРандомизированное исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод пока не подготовлен
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Funabashi Sayaka, Kataoka Yu, Nicholls Stephen J, Kitahara Satoshi, Makino Hisashi, Matsubara Masaki, Matsuo Miki, Omura-Ohata Yoko, Koezuka Ryo, Tochiya Mayu, Tamanaha Tamiko, Tomita Tsutomu, Honda-Kohmo Kyoko, Noguchi Michio, Murai Kota, Sawada Kenichiro, Iwai Takamasa, Matama Hideo, Honda Satoshi, Fujino Masashi, Nakao Kazuhiro, Yoneda Shuichi, Takagi Kensuke, Otsuka Fumiyuki, Asaumi Yasuhide, Hosoda Kiminori, Yasuda Satoshi, Noguchi Teruo
Аннотация
BACKGROUND: Type 2 diabetic patients exhibited an increased secretion of triglyceride-rich lipoproteins and low high-density lipoprotein cholesterol levels with a greater amount of small dense low-density lipoprotein (LDL). Given that apolipoprotein B (apoB), a proatherogenic lipoprotein, exists at both triglyceride-rich lipoproteins and LDL particles, circulating apoB may associate with diabetic coronary atherosclerosis.
METHODS: The OPTIMAL study was a prospective randomized-controlled study which employed serial near-infrared spectroscopy (NIRS)/intravascular ultrasound (IVUS) imaging to evaluate the efficacy of glycemic control on coronary atherosclerosis in 94 statin-treated type 2 diabetic patients with coronary artery disease (CAD) (UMIN000036721). Of these, 78 patients with both serial apoB levels and NIRS/IVUS images at baseline and week 48 were analyzed. NIRS/IVUS-derived plaque measures were compared in those with and without any reduction of apoB levels.
RESULTS: All of the study subjects received a statin, and 60.6% of the study subjects exhibited any reduction of apoB levels. There was no significant difference in the atheroma progression rate between the 2 groups (-0.27 ± 0.15% vs -0.33 ± 0.51%, P = .44). However, patients with any reduction of apoB levels exhibited a greater frequency of change in maximal lipid-core burden index at 4-mm segment (maxLCBI4mm) (-13.4 ± 22.2% vs 70.3 ± 28.7%, P = .03) and maxLCBI4mm regression (61.1 ± 0.08% vs 31.0 ± 0.09%, p = .02). Multivariate analysis demonstrated change in apoB as an independent factor associated with maxLCBI4mm regression (odds ratio = 0.92, 95% CI = 0.87-0.98, P = .01).
CONCLUSIONS: In statin-treated type 2 diabetic patients with CAD, a greater delipidation of coronary atherosclerosis was observed in association with a reduction of apoB levels. The current findings indicate a potential anti-atherosclerotic effect of lowering apoB levels, which may ultimately mitigate future coronary events risk in statin-treated type 2 diabetic patients with CAD.
METHODS: The OPTIMAL study was a prospective randomized-controlled study which employed serial near-infrared spectroscopy (NIRS)/intravascular ultrasound (IVUS) imaging to evaluate the efficacy of glycemic control on coronary atherosclerosis in 94 statin-treated type 2 diabetic patients with coronary artery disease (CAD) (UMIN000036721). Of these, 78 patients with both serial apoB levels and NIRS/IVUS images at baseline and week 48 were analyzed. NIRS/IVUS-derived plaque measures were compared in those with and without any reduction of apoB levels.
RESULTS: All of the study subjects received a statin, and 60.6% of the study subjects exhibited any reduction of apoB levels. There was no significant difference in the atheroma progression rate between the 2 groups (-0.27 ± 0.15% vs -0.33 ± 0.51%, P = .44). However, patients with any reduction of apoB levels exhibited a greater frequency of change in maximal lipid-core burden index at 4-mm segment (maxLCBI4mm) (-13.4 ± 22.2% vs 70.3 ± 28.7%, P = .03) and maxLCBI4mm regression (61.1 ± 0.08% vs 31.0 ± 0.09%, p = .02). Multivariate analysis demonstrated change in apoB as an independent factor associated with maxLCBI4mm regression (odds ratio = 0.92, 95% CI = 0.87-0.98, P = .01).
CONCLUSIONS: In statin-treated type 2 diabetic patients with CAD, a greater delipidation of coronary atherosclerosis was observed in association with a reduction of apoB levels. The current findings indicate a potential anti-atherosclerotic effect of lowering apoB levels, which may ultimately mitigate future coronary events risk in statin-treated type 2 diabetic patients with CAD.