J Clin Lipidol. 2025 Dec 15:S1933-2874(25)00540-9. doi: 10.1016/j.jacl.2025.12.011. Online ahead of print.
ABSTRACT
BACKGROUND: Obesity is a major risk factor for atherosclerotic cardiovascular disease (ASCVD). While lowering low-density lipoprotein cholesterol (LDL-C) reduces ASCVD, it remains unclear whether patients with obesity exhibit distinct plaque responses to LDL-C control.
OBJECTIVE: The current study sought to compare disease progression under achieving LDL-C <1.8 mmol/L in patients with type 2 diabetes mellitus (T2DM) and coronary artery disease (CAD) with and without obesity.
METHODS: This prespecified sub-analysis of the OPTIMAL randomized trial (jRCT1052180152; UMIN000036721) evaluated 78 statin-treated patients with T2DM and CAD who underwent serial intravascular ultrasound imaging. Change in percent atheroma volume (PAV) was compared in those with obesity (body mass index [BMI] ≥ 25 kg/m2, n = 31) and without (BMI <25 kg/m2, n = 47) stratified by achievement of LDL-C<1.8 mmol/l at 48 weeks.
RESULTS: LDL-C<1.8 mmol/L was attained in 41.9% with obesity and 57.4% without (P = .18). In participants without obesity, achieving LDL-C<1.8 mmol/L was not associated with significant change in PAV (-0.5 ± 0.4 vs. -0.3 ± 0.4%, P = .74) or regression frequency (59.3 vs. 62.0%, P = .85). In contrast, patients with obesity achieving LDL-C<1.8 mmol/L more often received high-intensity statins and demonstrated significant PAV regression (-0.9 ± 0.3 vs. 0.4 ± 0.2%, P = .006) and greater regression frequency (79.6 vs. 25.2%, P = .01).
CONCLUSION: A greater regression of coronary atheroma following LDL-C<1.8 mmol/L was observed in obese patients. Future dedicated study is warranted to further elucidate atheroma regression in response to LDL-C control in obese and non-obese patients.
PMID:41565499 | DOI:10.1016/j.jacl.2025.12.011