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Objective:To explore the differences of risk stratification of very high-risk or extreme high-risk atherosclerotic cardiovascular diseases (ASCVD) and the attainment rates of low-density lipoprotein cholesterol (LDL-C) management targets evaluated by three different criteria, and the causal attributions of these differences.Methods:Patients with ASCVD were consecutively enrolled from January 1 to December 31 in 2019, and were evaluated for very high-risk or extreme high-risk and LDL-C goal attainment rates with 2018 American guideline on the management of blood cholesterol (2018AG), 2019 China Cholesterol Education Program (CCEP) Expert Advice for the management of dyslipidemias (2019EA) and 2020 Chinese expert consensus on lipid management of very high-risk ASCVD patients(2020EC), respectively. The causal attributions of the differences in attainment rates were analyzed as well.Results:A total of 1 864 ASCVD patients were included in this study. According to 2018AG, 2019EA and 2020EC, the proportions of the patients with very high-risk or extreme high-risk were 59.4%, 90.7%, and 65.6%, respectively. The absolute LDL-C target attainment rates were 37.2%, 15.7%, and 13.7%, respectively, the differences between each two rates were statistically significant (all P<0.001). As to the differences in attainment rates between 2020EC and 2018AG, 61.5% were due to the different LDL-C goal attainment values and 38.5% were caused by the different risk stratifications, while for the differences between 2020EC and 2019EA attainment rates, different LDL-C goal attainment values were responsible for 13.2%, and different risk stratifications were responsible for 86.8% of the differences. Conclusions:There are significant differences in the proportions and LDL-C attainment rates among the three different criteria for very high-risk or extreme high-risk ASCVD. 2020EC showed a moderate proportion of patients with extreme high-risk, and had the lowest LDL-C attainment rate. The differences between 2020EC and 2018AG are mainly due to the LDL-C target values, and the differences between 2020EC and 2019EA are mainly caused by the risk stratifications.
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Objective@#Positron emission tomography-computed tomography (PET-CT) has been used to quantify inflammatory response in the body. The aim of the present study was to explore the possibility of using this method to evaluate the stability of atherosclerotic plaques and the efficacy of atorvastatin in stabilizing atherosclerotic plaques.@*Methods@#Twenty New Zealand male white rabbits were included and divided into the atorvastatin intervention group and the control group, with 10 rabbits in each group. Rabbits in both groups were fed with a high fat diet for 20 weeks, and treated with thoracoabdominal aortic balloon-pulling to establish atherosclerosis model at the end of the 2nd week. Rabbits in atorvastatin intervention group was given atorvastatin intragastrically once a day. At the 8th week, thoracoabdominal aortic ultrasound was used to detect plaques in all rabbits. Blood was drawn at the 3rd and the 20th week, respectively, to measure blood lipids, high-sensitive C-reactive protein (hs-CRP) and matrix metalloproteinase-9 (MMP-9). At the end of experiment, survival animals were scanned by 18F-FDG PET-CT, and the average and maximum standard uptake values (SUVmean, SUVmax) of aortic segments were measured. Thereafter, the animals were sacrificed and aortic specimens of rabbits were taken and examined by immunohistochemistry. The pathological indexes were measured and compared.@*Results@#At the end of experiment, the total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), hs-CRP [ (4.58±0.51) ng/ml vs.(5.87±0.66) ng/ml, P<0.01], MMP-9[ (43.93±2.16) ng/ml vs. (50.77±2.32) ng/ml, P<0.01], SUVmean (0.59±0.15 vs. 0.68±0.20, P<0.05) , SUVmax (0.68±0.20 vs. 0.81±0.27, P<0.05) , plaque area [ (0.36±0.24) mm2 vs. (0.50±0.34) mm2, P<0.05) ] and density of macrophage[ (4.34±1.54) % vs. (5.65±1.89) %, P<0.01] in the atorvastatin intervention group were significantly lower than those in the control group. In contrast, fiber cap thickness of the plaque[ (4.12±0.66) μm vs. (2.96±0.37) μm, P<0.01] in the atorvastatin intervention group was higher than that of the control group, and the difference was statistically significant. The arterial plaque areas were positively correlated with SUVmean (r=0.27, P<0.05) and SUVmax (r=0.43, P<0.01) . Fiber cap thickness was negatively correlated with SUVmean (r=-0.38, P<0.05) and SUVmax (r=-0.47, P<0.01) . The density of macrophage were positively correlated with SUVmean (r=0.52, P<0.01) and SUVmax (r=0.51, P<0.01) .@*Conclusion@#18F-FDG PET/CT can be used to evaluate the efficacy of atorvastatin by the stability of atherosclerotic plaques.
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Purpose 18F-FDG PET/CT,pathological and immunohistochemical analysis are adopted to explore the value of PET/CT in the early-stage calcification examination of atherosclerosis in rabbits and effects of Pioglitazone in treating early-stage calcification.Material and Methods Sixteen New Zealand male rabbits were randomly divided into two groups:Pioglitazone group and control group,witheight rabbits in each group.Atherosclerosis model was established.Rabbits in Pioglitazone group received gavage with Pioglitazone and were raised with high-fat diet for 20 weeks.Blood was drawn to exam high sensitivity C-reactive protein and matrix metalloproteinase-9.PET/CT was used to measure mean standardized uptake value (SUVmean) and maximum standardized uptake value (SUVmax).Rabbit aorta received immunohistochemical,the plaque area,density of macrophage,percentage of calcification area and apoptosis index between the two groups were determined and compared.Results On 20 week,high sensitivity C-reactive protein in Pioglitazone group (4.27±0.43 vs.6.51 ±0.91,P＜0.01),matrix metalloproteinase-9 (41.52± 1.99 vs.62.21 ±3.60,P＜0.05),SUVmean (0.55±0.18 vs.0.68±0.21,P＜0.01)and SUVmax (0.70±0.19 vs.0.82±0.30,P＜0.05) were obviously lower than those in control group.Plaque area,density of macrophage,percentage of calcification area and apoptosis index in control group were obviously higher than those in Pioglitazone group.Plaque area of related artery section was positively correlated with SUVmean (r=0.28,P＜0.01) and SUVmax (r=0.25,P＜0.05).Density of macrophage was positively correlated with SUVmean (r=0.50,P＜0.01) and SUVmax (r=0.46,P＜0.01).Percentage of calcification area was positively correlated with SUVmean (r=0.50,P＜0.01) and SUVmax (r=0.47,P＜0.01).Apoptosis index was positively correlated with SUVmean (r=0.61,P＜0.01)and SUVmax (r=0.60,P＜0.01).Conclusion Inflammation and macrophage apoptosis are of great importance in the early-stage of atherosclerosis.18F-FDG PET/CT imaging can be used to assess minor calcification.Pioglitazone can reduce inflammatory level of atherosclerosis of the experimented animals,inhibiting early-stage calcification.