{"title":"他汀类药物治疗的2型糖尿病合并冠状动脉疾病患者的循环载脂蛋白B水平：对冠状动脉粥样硬化进展和不稳定性的影响","authors":"Sayaka Funabashi, Yu Kataoka, Stephen J Nicholls, Satoshi Kitahara, Hisashi Makino, Masaki Matsubara, Miki Matsuo, Yoko Omura-Ohata, Ryo Koezuka, Mayu Tochiya, Tamiko Tamanaha, Tsutomu Tomita, Kyoko Honda-Kohmo, Michio Noguchi, Kota Murai, Kenichiro Sawada, Takamasa Iwai, Hideo Matama, Satoshi Honda, Masashi Fujino, Kazuhiro Nakao, Shuichi Yoneda, Kensuke Takagi, Fumiyuki Otsuka, Yasuhide Asaumi, Kiminori Hosoda, Satoshi Yasuda, Teruo Noguchi","doi":"10.1016/j.jacl.2025.04.204","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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 (maxLCBI<sub>4mm</sub>) (-13.4 ± 22.2% vs 70.3 ± 28.7%, P = .03) and maxLCBI<sub>4mm</sub> regression (61.1 ± 0.08 vs 31.0 ± 0.09%, p = .02). Multivariate analysis demonstrated change in apoB as an independent factor associated with maxLCBI<sub>4mm</sub> regression (odds ratio = 0.92, 95% CI = 0.87-0.98, P = .01).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":" ","pages":""},"PeriodicalIF":3.6000,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Circulating apolipoprotein B levels in statin-treated type 2 diabetic patients with coronary artery disease: Implications for coronary atheroma progression and instability.\",\"authors\":\"Sayaka Funabashi, Yu Kataoka, Stephen J Nicholls, Satoshi Kitahara, Hisashi Makino, Masaki Matsubara, Miki Matsuo, Yoko Omura-Ohata, Ryo Koezuka, Mayu Tochiya, Tamiko Tamanaha, Tsutomu Tomita, Kyoko Honda-Kohmo, Michio Noguchi, Kota Murai, Kenichiro Sawada, Takamasa Iwai, Hideo Matama, Satoshi Honda, Masashi Fujino, Kazuhiro Nakao, Shuichi Yoneda, Kensuke Takagi, Fumiyuki Otsuka, Yasuhide Asaumi, Kiminori Hosoda, Satoshi Yasuda, Teruo Noguchi\",\"doi\":\"10.1016/j.jacl.2025.04.204\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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 (maxLCBI<sub>4mm</sub>) (-13.4 ± 22.2% vs 70.3 ± 28.7%, P = .03) and maxLCBI<sub>4mm</sub> regression (61.1 ± 0.08 vs 31.0 ± 0.09%, p = .02). Multivariate analysis demonstrated change in apoB as an independent factor associated with maxLCBI<sub>4mm</sub> regression (odds ratio = 0.92, 95% CI = 0.87-0.98, P = .01).</p><p><strong>Conclusions: </strong>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.</p>\",\"PeriodicalId\":15392,\"journal\":{\"name\":\"Journal of clinical lipidology\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":3.6000,\"publicationDate\":\"2025-05-07\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of clinical lipidology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.jacl.2025.04.204\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"PHARMACOLOGY & PHARMACY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of clinical lipidology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.jacl.2025.04.204","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"PHARMACOLOGY & PHARMACY","Score":null,"Total":0}
引用次数: 0
摘要
背景：2型糖尿病患者表现为富含甘油三酯的脂蛋白分泌增加，高密度脂蛋白胆固醇水平低，小密度低密度脂蛋白（LDL）含量较高。考虑到载脂蛋白B （apoB）是一种致动脉粥样硬化的脂蛋白，存在于富含甘油三酯的脂蛋白和LDL颗粒中，循环载脂蛋白B可能与糖尿病冠状动脉粥样硬化有关。方法：OPTIMAL研究是一项前瞻性随机对照研究，采用连续近红外光谱(NIRS)/血管内超声（IVUS）成像技术评估94例他汀类药物治疗的2型糖尿病合并冠心病（CAD）患者（UMIN000036721）的血糖控制对冠状动脉粥样硬化的疗效。其中，78例患者在基线和第48周的序列载脂蛋白水平和NIRS/IVUS图像进行了分析。NIRS/ ivus衍生的斑块测量在载脂蛋白ob水平降低和未降低的情况下进行比较。结果：所有的研究对象接受了他汀类药物治疗，60.6%的研究对象表现出载脂蛋白水平的降低。两组患者的动脉粥样硬化进展率差异无统计学意义（-0.27±0.15% vs -0.33±0.51%,P = 0.44）。然而，apoB水平降低的患者在4-mm段（maxLCBI4mm）的最大脂质核心负担指数变化频率更高（-13.4±22.2% vs 70.3±28.7%,P = 0.03）， maxLCBI4mm回归频率更高（61.1±0.08 vs 31.0±0.09%,P = 0.02）。多因素分析表明，apoB的变化是与maxLCBI4mm回归相关的独立因素（优势比= 0.92,95% CI = 0.87-0.98, P = 0.01）。结论：在他汀类药物治疗的2型糖尿病合并冠心病患者中，观察到冠状动脉粥样硬化的更大脱脂与载脂蛋白ob水平的降低有关。目前的研究结果表明，降低载脂蛋白ob水平具有潜在的抗动脉粥样硬化作用，这可能最终降低他汀类药物治疗的2型糖尿病合并CAD患者未来冠状动脉事件的风险。
Circulating apolipoprotein B levels in statin-treated type 2 diabetic patients with coronary artery disease: Implications for coronary atheroma progression and instability.
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.
期刊介绍：
Because the scope of clinical lipidology is broad, the topics addressed by the Journal are equally diverse. Typical articles explore lipidology as it is practiced in the treatment setting, recent developments in pharmacological research, reports of treatment and trials, case studies, the impact of lifestyle modification, and similar academic material of interest to the practitioner.
Sections of Journal of clinical lipidology will address pioneering studies and the clinicians who conduct them, case studies, ethical standards and conduct, professional guidance such as ATP and NCEP, editorial commentary, letters from readers, National Lipid Association (NLA) news and upcoming event information, as well as abstracts from the NLA annual scientific sessions and the scientific forums held by its chapters, when appropriate.
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