Clinical impact of dyslipidemia for coronary plaque vulnerability in acute coronary syndrome without metabolic syndrome

Summary Background Although the metabolic syndrome is associated with incident cardiovascular disease, low-density lipoprotein (LDL) cholesterol is a well-known risk factor for coronary atherosclerosis. The aim of this study was to clarify the clinical markers for coronary plaque vulnerability in acute coronary syndrome (ACS) patients (men) without the metabolic syndrome. Methods Consecutive Japanese men with ACS (n = 264) underwent emergent coronary angiography and B-mode carotid ultrasonography. Common carotid intima-media thickening and vascular dilatation were considered to indicate carotid artery remodeling. Patients were divided into two groups based on the number of complex plaques identified by coronary angiography. Results Abdominal obesity and low high-density lipoprotein cholesterol levels were frequently observed in overall patients with multiple complex coronary lesions. Although the metabolic syndrome was a significant independent predictor of multiple complex coronary lesions in overall ACS patients, a high LDL cholesterol level was an independent predictor in ACS patients without the metabolic syndrome. Carotid artery remodeling was an independent predictor of multiple complex coronary lesions in both overall patients and patients without the metabolic syndrome. Conclusion In ACS patients without the metabolic syndrome, high LDL cholesterol levels and carotid artery remodeling are important indicators for assessing the efficacy of aggressive treatments for secondary prevention of ACS.