Progression of Coronary Atherosclerosis Analyzed

March 8, 2011—In the Journal of the American College of Cardiology, Ayman A. Hussein, MD, et al published findings from an analysis that sought to characterize the progression of coronary atherosclerosis in patients with concomitant peripheral arterial disease (PAD) (2011;57:1220–1225). Although PAD is associated with adverse cardiovascular outcomes, the impact of concomitant PAD on coronary atherosclerosis progression in patients with coronary artery disease has not been well established, the investigators noted.

The investigators concluded that patients with concomitant PAD were found to have a higher incidence of extensive and calcified coronary atherosclerosis, constrictive arterial remodeling, and greater disease progression. These changes likely contribute to adverse cardiovascular outcomes. The benefit for all patients in achieving low levels of low-density lipoprotein cholesterol supports the need for intensive lipid lowering in patients with PAD, the investigators concluded.

In this analysis, the burden and progression of coronary atherosclerosis was investigated in 3,479 patients with coronary artery disease with (n = 216) and without (n = 3,263) concomitant PAD, who participated in seven clinical trials that employed serial intravascular ultrasound imaging.

The investigators reported that patients with PAD had a greater percent atheroma volume (40.4% ± 9.2% vs 38.5% ± 9.1%; P = .002) and percentage of images containing calcium (35.1% ± 26.2% vs 29.6% ± 24.2%; P = .002) in association with smaller lumen volume (275.7 ± 101.6 mm³ vs 301.4 ± 110.3 mm³; P < .001) and vessel wall volume (467.7 ± 166.8 mm³ vs 492.9 ± 169.8 mm³; P = .01).

On serial evaluation, patients with PAD showed greater progression of percent atheroma volume (+0.58% ± 0.38% vs +0.23% ± 0.3%; P = .009) and total atheroma volume (–0.17 ± 2.69 mm³ vs –2.05 ± 2.15 mm³; P = .03) and experienced more cardiovascular events (26.3% vs 19.8%; P = .03). In patients with PAD and without PAD, respectively, achieving levels of low-density lipoprotein cholesterol < 70 mg/dL was associated with less progression of percent atheroma volume (+0.16% ± 0.27% vs +0.76% ± 0.2%; P = .04; and +0.05% ± 0.14% vs +0.29% ± 0.13%; P < .001) and total atheroma volume (–3 ± 1.9 mm³ vs +1 ± 1.4 mm³; P = .04; and –3.3 ± 1.1 mm3 vs –1.6 ± 1 mm³; P < .001), as detailed in the Journal of the American College of Cardiology.