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第68届美国心脏病学会科学年会（ACC 2019）于3月16日至18日在新奥尔良Ernest N. Morial会议中心举办。中国人民解放军总医院陈韵岱教授团队提交了一项研究，探讨了中国人群中降低LDL-C水平对冠状动脉斑块的影响。本研究由陈韵岱教授团队与哈佛大学、布莱根妇女医院联合完成，中国人民解放军总医院第一医学中心心血管内科的杨俊杰博士作为第一作者参与了壁报现场展示活动。

研究简介

本研究旨在探讨中低剂量的他汀类药物是否会使中国人群的冠状动脉斑块发生消退，连续纳入了转诊至中国大型医疗中心、接受连续冠状动脉CT血管造影（CTA）的患者。在基线和随访做CTA时，同时检测LDL-C水平；分析冠脉斑块体积，包括总斑块和非钙化斑块。

共纳入287名患者，平均年龄59.7岁，男性占70％。两次扫描的中位时间间隔为21个月。基线时，有76人（27％）接受他汀类药物治疗，基线CTA后112人（39％）开始他汀治疗。

在多变量分析中，相对LDL-C降低与年总斑块消退独立相关（OR=0.948 per 1% LDL-C, p<0.001）。

此外，在具有较高基线LDL-C（> 100 mg/dL）和LDL-C降低> 25％的个体中观察到斑块消退量较大：总斑块（-12.45 mm³，p <0.001），非钙化斑块（-12.67mm³，p <0.001）。

研究表明，低、中强度的他汀类药物治疗的中国人可能出现明显的斑块消退，特别是那些基线LDL-C水平较高或LDL-C降低> 25％的患者。

研究摘要

Title: Reduction in LDL-Cholesterol Is Associated With Regression of Coronary Plaque Among Chinese Individuals（1229-368 / 368）

Authors: Junjie Yang, Xi Wang, Guanhua Dou, Dongkai Shan, Jing Jing, Peter Stone, Yundai Chen, Marcelo Di Carli, Ron Blankstein, Chinese PLA General Hospital, Beijing, People's Republic of China, Harvard Medical School, Boston, MA, USA

Background: It is unknown whether low-to-moderate statin therapy can result in coronary plaque regression among Chinese individuals.

Methods: We included consecutive patients referred to a large medical center in China who underwent serial coronary computed tomography angiography (CTA) scans. Reduction in LDL-C level was determined by calculating the difference in LDL-C from the baseline scan to the follow-up scan. Coronary plaque volume -- including total plaque & noncalcified plaque -- were calculated using validated semi-automated quantitative plaque analysis software.

Results: A total of 287 patients (age 59.7; 70% male) were included. The median time between the two scans was 21 months. A total of 76 (27%) patients were on statin therapy at baseline, and 112 (39%) were initiated on therapy following the baseline CTA study. In multivariate analysis, a relative LDL-C reduction was independently associated with greater annual total plaque regression (OR=0.948 per 1% LDL-C, p<0.001). Furthermore, the larger amount of plaque regression was observed among individuals with higher baseline LDL-C (>100 mg/dL) and those that achieved >25% LDL-C reduction: total plaque (-12.45mm3, p<0.001), non-calcified plaque (-12.67mm3, p<0.001), see Figure.

Conclusion: Chinese individuals treated with low-to-moderate intensity statins can experience significant plaque regression, particularly for those with high baseline LDL-C level and when a reduction of LDL-C of 25% or greater is achieved.

专题链接>>> 第68届美国心脏病学会科学年会（ACC 2019）