Metabolic and Renal Dysfunction Are Associated With Intraplaque Lipid Burden Assessed by Near-Infrared Spectroscopy Intravascular Ultrasound: Insights Into the Cardiovascular-Kidney-Metabolic Axis.

Abstract

BACKGROUND: The cardiovascular-kidney-metabolic framework emphasizes the interrelated contributions of metabolic and renal dysfunction to cardiovascular risk. Whether these disturbances are reflected in coronary plaque composition remains incompletely understood. We evaluated the association of metabolic and renal dysfunction with intraplaque lipid burden using near-infrared spectroscopy intravascular ultrasound. METHODS: Intraplaque lipid burden was assessed by the maximum lipid core burden index (LCBI) within a 4-mm segment (maxLCBI4mm), and lipid-rich plaque (LRP) was defined as maxLCBI4mm≥324.7. Multivariable linear regression models were constructed with maxLCBI4mm as the dependent variable, and multivariable logistic regression models were used to evaluate associations with LRP. RESULTS: Among 483 patients undergoing percutaneous coronary intervention with pre-intervention near-infrared spectroscopy intravascular ultrasound imaging, lower estimated glomerular filtration rate and higher hemoglobin A1c were independently associated with greater intraplaque lipid burden and higher odds of LRP. In analyses standardized per 1 SD, low-density lipoprotein cholesterol showed the strongest association with maxLCBI4mm (β=52.51; 95% CI, 27.49-77.53), followed by estimated glomerular filtration rate (β=33.38; 95% CI, 9.97-56.80) and hemoglobin A1c (β=24.71; 95% CI, 3.71-45.71). Similarly, lower estimated glomerular filtration rate (odds tatio [OR], 1.36; 95% CI, 1.06-1.75) and higher hemoglobin A1c (OR, 1.37; 95% CI, 1.05-1.77) were independently associated with LRP. No significant interaction between estimated glomerular filtration rate and hemoglobin A1c was observed. CONCLUSIONS: Metabolic and renal dysfunction are independently associated with intraplaque lipid burden assessed by near-infrared spectroscopy intravascular ultrasound. These findings provide intracoronary imaging evidence linking the cardiovascular-kidney-metabolic framework to plaque-level lipid accumulation.

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