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CLINICAL STUDIES

Arterial remodeling in the left coronary system¹

The role of high-density lipoprotein cholesterol

Allen J. Taylor, MD, FACC^*, Allen P. Burke, MD, Andrew Farb, MD, FACC, Pouya Yousefi, Gray T. Malcom, PhD, John Smialek, MD and Renu Virmani, MD, FACC

^* Department of Hematology and Vascular Biology, Walter Reed Army Institute of Research, Washington, DC, USA
Louisiana State University, New Orleans, Louisiana, USA
University of Maryland, Baltimore, Maryland, USA
Cardiovascular Division, Armed Forces Institute of Pathology, Washington, DC, USA

Manuscript received March 19, 1998; revised manuscript received April 2, 1999, accepted May 16, 1999.

OBJECTIVES

We sought to evaluate the plaque and patient variables related to arterial remodeling responses of early, de novo atherosclerotic lesions involving the left coronary artery.

BACKGROUND

Coronary artery remodeling is a lesion-specific process involving either enlargement or shrinkage of atherosclerotic coronary arteries. There are little histologic data available correlating plaque morphologic and patient clinical characteristics with the degree and type of arterial remodeling in early atherosclerosis.

METHODS

We studied 736 serial arterial sections from the left coronary system of 97 autopsy cases (mean age 33 ± 11 years) by correlating the arterial remodeling response to plaque with demographic, serologic and histologic variables. Using the most proximal section as a reference, and considering the expected degree of internal elastic lamina tapering, remodeling was classified as positive (including neutral remodeling or compensatory enlargement) or negative.

RESULTS

Remodeling was classified as positive in 84.3% (compensatory in 30.6%) and negative in 15.7% of sections with an overall mean luminal stenosis of 10.4 ± 9.9%. In the lesions with the greatest arterial cross-sectional narrowing from each case, compensatory enlargement was associated with higher high-density lipoprotein (HDL) cholesterol (59.4 ± 27.2 mg/dl) compared with either neutral (49.3 ± 15.5 mg/dl) or negative remodeling (30.4 ± 5.2 mg/dl; p = 0.019). In subjects with advanced atherosclerosis (maximum American Heart Association histologic grade 5 atherosclerosis), there was a modest linear relationship between higher HDL cholesterol and the propensity for positive remodeling (r²= 0.37; p = 0.025). On multivariate analysis, only HDL cholesterol was related to the arterial remodeling response.

CONCLUSIONS

Negative arterial remodeling occurs in early atherosclerosis. Higher HDL cholesterol may favor positive remodeling.

Abbreviations and Acronyms   AHA = American Heart Association   ANOVA = analysis of variance   CSA = cross-sectional area   EEL = external elastic lamina   HDL = high-density lipoprotein   IEL = internal elastic lamina   LAD = left anterior descending coronary artery   LCX = left circumflex coronary artery

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