Presence and severity of coronary artery disease in patients who achieved intensive blood pressure reduction at the time of coronary computed tomography angiography.

Blood pressure (BP)-lowering treatment should be aimed at achieving intensive BP control. Coronary computed tomography angiography (CCTA) has become more widely available and enables the accurate noninvasive assessment of coronary artery stenosis for screening. The presence and severity of coronary artery disease (CAD) in patients who achieved intensive BP control at the time of CCTA were compared to those in patients without hypertension (HTN). Nine hundred eighty-five consecutive subjects who were clinically suspected of having CAD or who had at least one cardiac risk factor underwent CCTA. The patients were divided into four groups: patients without HTN (non-HTN group), hypertensive patients who underwent intensive BP lowering (intensive group, <130/80 mmHg), patients who underwent standard BP lowering (standard group, 130-139/80-89 mmHg) and patients with uncontrolled BP (uncontrolled group, >140/90 mmHg). Interestingly, %CAD in the Intensive group was significantly higher than that in patients without HTN. The Intensive group was older and had a higher body mass index, more significantly stenosed coronary vessels, lower levels of high-density lipoprotein cholesterol in the blood, and higher rates of dyslipidemia, diabetes, and anti-dyslipidemia and anti-diabetic medication use than the non-HTN group. The presence of CAD in the Intensive group was independently associated with age, male and smoking, whereas the presence of CAD in the non-HTN group was associated with age, male and family history. Finally, predictors of the number of VDs in the non-HTN and intensive BP-lowering groups were age, male, DL, and intensive BP lowering. In conclusion, these results suggest that hypertensive patients need more rigorous management of other coronary risk factors, despite receiving intensive BP-lowering treatment.

Associations Between High Levels of High-Density Lipoprotein Cholesterol and the Presence and Severity of Coronary Artery Disease in Patients Who Have Undergone Coronary Computed Tomography Angiography.

BACKGROUND: Although a recent study in a Japanese cohort indicated that extremely high-density lipoprotein cholesterol (HDL-C, ≥ 90 mg/dL) had an adverse effect on atherosclerotic cardiovascular disease mortality, we could not conclude that high levels of HDL-C were associated with the presence or severity of coronary artery disease (CAD). METHODS: We enrolled 1,016 patients who were clinically suspected to have CAD and who underwent coronary computed tomography angiography (CCTA). The number of significantly stenosed coronary vessels (vessel disease (VD), ≥ 50% coronary stenosis is diagnosed as CAD) and the Gensini score were quantified using CCTA, and the lipid profile was measured. The patients were divided into four groups according to the HDL-C level: < 40 mg/dL (n = 115, low), 40 - 59 mg/dL (n = 530, normal), 60 - 89 mg/dL (n = 335, high) and ≥ 90 mg/dL (n = 36, very-high). RESULTS: The percentage (%) of CAD in the low, normal, high and very-high groups was 69%, 55%, 42% and 25%, respectively (P for trend < 0.01). The Gensini score in the low, normal, high and very-high groups was 20 ± 25, 12 ± 16, 8 ± 12 and 4 ± 6, respectively (P for trend < 0.01). The very-high group showed the lowest triglyceride (TG) levels among the four groups. There were no significant differences in the level of low-density lipoprotein cholesterol or % use of statin among the four groups. Finally, the presence of CAD was independently associated with a low level of HDL-C, in addition to age, male, high systolic blood pressure and hemoglobin A1c, but not TG, by a multivariate logistic regression analysis. CONCLUSIONS: High levels of HDL-C at the time of CCTA for screening were associated with a reduced presence and severity of CAD.