Oxidized low-density lipoprotein cholesterol and plaque vulnerability

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Background The oxidation of low-density lipoprotein cholesterol (LDL-C) plays a critical role in plaque inflammation and the subsequent high-risk plaque formation. However, the relationship between LDL-C oxidation and plaque morphology in patients with diabetes mellitus (DM) has not been systematically studied. The study aimed to investigate the association between LDL-C oxidation and plaque morphology assessed using optical coherence tomography (OCT). Methods A total of 138 patients with chronic coronary syndrome who underwent OCT were analyzed. Malondialdehyde-modified LDL-C (MDA-LDL), a representative form of oxidized LDL-C, was measured. Levels of LDL-C oxidation were assessed using the ratio of MDA-LDL to LDL-C ratio. Plaque morphology was assessed by OCT at the target lesions. Results Patients were divided into three groups according to the tertiles of LDL-C oxidation levels. Lipid index and macrophage grade were significantly higher in patients with higher levels of LDL-C oxidation in patients with DM (low vs. moderate vs. high; lipid index: 714 vs. 1226 vs. 2217, p for trend = 0.040; macrophage grade: 2 vs. 7 vs. 13, p for trend = 0.009). In contrast, no association was found in patients without DM (low vs. moderate vs. high; lipid index: 1109 vs. 1181 vs. 1436, p for trend = 0.633; macrophage grade: 8 vs. 5 vs. 8, p for trend = 0.748). Those associations remained significant even after adjusting for confounders in patients with DM but not in those without. Conclusions The levels of LDL-C oxidation were associated with plaque vulnerability, especially in patients with DM.

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