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Cholesterol crystals may predict MI
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Cholesterol crystals have been linked to increased arterial narrowing, increased inflammation and decreased reflow after PCI, according to a study published in the American Journal of Cardiology.
“Now that we’ve shown how extensive cholesterol crystals are irritating and blocking off these arteries, treatments that dissolve these crystals may be used to reduce heart damage,” George S. Abela, MD, MBA, MSc, professor of medicine, chief of the division of cardiology and cardiology fellowship director at Michigan State University in East Lansing, said in a press release.
Researchers analyzed data from 286 patients with acute MI and either a total or partial artery occlusion. Samples were extracted from the occluded coronary and reviewed for the presence of crystals, size, composition and serum level measurements.
Cholesterol crystals were seen in 89% of patients (mean age, 60 years; 76% men), 60% of whom had moderate to extensive cholesterol crystal content. Patients with totally occluded arteries had larger crystal clusters (46,760 µm2) vs. those with partially occluded arteries (33,167 µm2; P < .03).
Those with crystal cluster areas in the highest tertile were more likely to have a TIMI 1 flow grade (P < .01) and less likely to have a TIMI 3 blush grade (P < .01).
Patients with the two highest tertiles of crystal cluster area had higher interleukin-1 beta levels vs. those with no crystals (P < .01).
Smaller cholesterol crystal cluster areas were seen in patients with recurrent acute MI (P < .04), in addition to lower troponin (P < .02) and interleukin-1 beta levels (P < .04).
Women had a smaller crystal cluster area (31,340 µm2) vs. men (45,798 µm2; P < .03).
Macrophages were attached to cholesterol crystals. During acute MI, coronary artery aspirates had a large number of crystal deposits.
“The current study suggests that [cholesterol crystals] appear to have an active role in [acute] MI, raising an intriguing perspective of atherosclerosis as a crystalloid disease,” Abela and colleagues wrote. – by Darlene Dobkowski
Disclosures: Abela reports he received a grant from Merck, serves on an advisory board for Merck, consults for Novartis and is a speaker for Amgen and Daiichi Sankyo. Please see the study for all other authors’ relevant financial disclosures.
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