Impact of apolipoprotein B control on coronary atherosclerotic plaque progression: a cohort study using intravascular ultrasound

doi:10.3969/j.issn.1674-8115.2026.03.005

Abstract

Abstract:

Objective ·To investigate the correlation between apolipoprotein B (ApoB) control level and coronary plaque progression in patients with stable coronary atherosclerotic heart disease (CHD). Methods ·This study retrospectively enrolled 86 patients with stable CHD (146 lesions) who were treated in the Department of Cardiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, from January 2020 to May 2023. At baseline, demographic characteristics, physical examination finding, medical history, and medication use were collected. At baseline and follow-up, cardiometabolic parameters (including blood lipids and blood glucose) were measured, and intravascular ultrasound (IVUS) was performed to evaluate the same untreated intermediate coronary lesions (stenosis rate 30%‒70%). Time-averaged values of cardiometabolic parameters during follow-up were calculated. Quantitative analysis was performed on IVUS images to measure total atheroma volume (TAV) and percent atheroma volume (PAV) at baseline and follow-up. Patients were divided into a plaque progression group and a non-progression group according to a cutoff value of PAV change ≥5%. Spearman correlation analysis and multivariate Logistic regression were used to evaluate the association between time-averaged ApoB control level and coronary plaque progression. Results ·During follow-up, the mean change in PAV was 3.6% (-2.7%, 9.7%), and plaque progression was detected in 65 lesions (44.5%). A positive correlation was observed between time-averaged ApoB control level and mean change in TAV (r=0.22, P=0.008). Multivariate logistic regression analysis further demonstrated that, after adjustment, each 0.1 mmol/L increase in time-averaged ApoB control level was associated with a 0.885-fold increase in the risk of plaque progression (P=0.048). Conclusion ·Higher ApoB levels remain an independent predictor of coronary plaque progression after adjustment for potential confounders. These findings suggest that comprehensive management of cardiometabolic parameters, including ApoB, should be strengthened in clinical practice to delay plaque progression and improve patient prognosis.

Key words: coronary atherosclerotic heart disease (CHD), plaque progression, apolipoprotein B (ApoB), intravascular ultrasound (IVUS)

CLC Number:

R543.3

Amuti Abulikemu, Li Youran, Yang Chendie, GuanPoh Tay, Feng Shuo, Zhang Ruiyan, Wang Xiaoqun. Impact of apolipoprotein B control on coronary atherosclerotic plaque progression: a cohort study using intravascular ultrasound[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2026, 46(3): 312-321.

Figures/Tables 7

TrendMD

References 28

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Variable	Plaque non-progression group (n=38)	Plaque progression group (n=48)	P value
Male/n(%)	32 (84.2)	31 (64.6)	0.072
Age/year	63.5 (58.3, 70.0)	61.0 (56.8, 67.3)	0.208
BMI/(kg·m^-2)	25.8 (23.4, 26.7)	25.50 (23.3, 26.9)	0.986
Systolic blood pressure/mmHg	139.0 (124.0, 152.5)	139.5 (129.0, 154.0)	0.852
Diastolic blood pressure/mmHg	78.0 (70.0, 86.5)	78.0 (70.0, 85.5)	0.818
History of diabetes mellitus/n(%)	14 (36.8)	18 (37.5)	1.000
History of hypertension/n(%)	22 (57.9)	33 (68.8)	0.415
History of smoking/n(%)	20 (52.6)	17 (35.4)	0.167
Dyslipidemia/n(%)	18 (47.4)	37 (77.1)	0.009
ACEI/ARB/n(%)	13 (34.2)	21 (43.8)	0.499
ARNI/n(%)	6 (15.8)	5 (10.4)	0.678
SGLT2 inhibitors/n(%)	7 (18.4)	4 (8.3)	0.286
CCBs/n(%)	9 (23.7)	18 (37.5)	0.256
PCSK9 inhibitors/n(%)	3 (7.9)	6 (12.5)	0.735
Statins/n(%)	30 (78.9)	43 (89.6)	0.287
Aspirin/n(%)	33 (86.8)	44 (91.7)	0.711
P2Y₁₂ receptor inhibitors/n(%)	35 (92.1)	46 (95.8)	0.787
β blockers/n(%)	20 (52.6)	22 (45.8)	0.682
hsCRP/(mg·L^-1)	0.81 (0.39, 2.30)	1.96 (0.45, 3.09)	0.280
eGFR/[mL·(min·1.73 m²)^-1]	94.7 (87.0, 102.4)	92.5 (87.7, 104.7)	0.709
Lesion distribution/n(%)
LM	5 (6.2)	14 (21.5)	0.013
LAD	55 (67.9)	38 (58.5)	0.315
LCX	4 (4.9)	0 (0)	0.191
RCA	17 (21.0)	13 (20.0)	1.000
SYNTAX score/score	15.0 (9.0, 21.8)	23.0 (17.3, 31.3)	0.006
Gensini score/score	21.5 (13.1, 33.8)	29.3 (22.0, 49.3)	0.006

Variable	Plaque non-progression group (n=38)	Plaque progression group (n=48)	P value
Male/n(%)	32 (84.2)	31 (64.6)	0.072
Age/year	63.5 (58.3, 70.0)	61.0 (56.8, 67.3)	0.208
BMI/(kg·m^-2)	25.8 (23.4, 26.7)	25.50 (23.3, 26.9)	0.986
Systolic blood pressure/mmHg	139.0 (124.0, 152.5)	139.5 (129.0, 154.0)	0.852
Diastolic blood pressure/mmHg	78.0 (70.0, 86.5)	78.0 (70.0, 85.5)	0.818
History of diabetes mellitus/n(%)	14 (36.8)	18 (37.5)	1.000
History of hypertension/n(%)	22 (57.9)	33 (68.8)	0.415
History of smoking/n(%)	20 (52.6)	17 (35.4)	0.167
Dyslipidemia/n(%)	18 (47.4)	37 (77.1)	0.009
ACEI/ARB/n(%)	13 (34.2)	21 (43.8)	0.499
ARNI/n(%)	6 (15.8)	5 (10.4)	0.678
SGLT2 inhibitors/n(%)	7 (18.4)	4 (8.3)	0.286
CCBs/n(%)	9 (23.7)	18 (37.5)	0.256
PCSK9 inhibitors/n(%)	3 (7.9)	6 (12.5)	0.735
Statins/n(%)	30 (78.9)	43 (89.6)	0.287
Aspirin/n(%)	33 (86.8)	44 (91.7)	0.711
P2Y₁₂ receptor inhibitors/n(%)	35 (92.1)	46 (95.8)	0.787
β blockers/n(%)	20 (52.6)	22 (45.8)	0.682
hsCRP/(mg·L^-1)	0.81 (0.39, 2.30)	1.96 (0.45, 3.09)	0.280
eGFR/[mL·(min·1.73 m²)^-1]	94.7 (87.0, 102.4)	92.5 (87.7, 104.7)	0.709
Lesion distribution/n(%)
LM	5 (6.2)	14 (21.5)	0.013
LAD	55 (67.9)	38 (58.5)	0.315
LCX	4 (4.9)	0 (0)	0.191
RCA	17 (21.0)	13 (20.0)	1.000
SYNTAX score/score	15.0 (9.0, 21.8)	23.0 (17.3, 31.3)	0.006
Gensini score/score	21.5 (13.1, 33.8)	29.3 (22.0, 49.3)	0.006

Variable	Group	Baseline	Follow-up
Variable	Group	Baseline	Time-averaged	Mean	SD	CV
HbA1c/%	Plaque non-progression	6.00 (5.60, 6.47)	6.12 (5.71, 6.44)	6.08 (5.71, 6.71)	0.21 (0.13, 0.35)	3.69 (2.33, 5.66)
	Plaque progression	6.05 (5.70, 6.75)	6.09 (5.74, 6.64)	6.09 (5.74, 6.79)	0.23 (0.14, 0.44)	4.17 (2.24, 6.27)
	P value	0.685	0.715	0.784	0.769	0.691
TC/(mmol·L^-1)	Plaque non-progression	3.70 (3.21, 4.40)	3.36 (2.95, 3.81)	3.38 (2.96, 3.88)	0.35 (0.18, 0.74)	11.38 (6.47, 21.09)
	Plaque progression	3.83 (3.24, 5.02)	3.57 (3.07, 4.01)	3.65 (3.12, 4.15)	0.57 (0.40, 0.89)	15.23 (10.51, 24.96)
	P value	0.268	0.198	0.220	0.018	0.055
TAG/(mmol·L^-1)	Plaque non-progression	1.27 (0.97, 1.59)	1.26 (0.92, 1.50)	1.26 (0.92, 1.50)	0.20 (0.10, 0.35)	19.51 (8.86, 28.66)
	Plaque progression	1.73 (1.21, 2.15)	1.50 (1.22, 1.93)	1.50 (1.26, 1.95)	0.31 (0.21, 0.54)	20.71 (15.42, 34.00)
	P value	0.009	0.010	0.008	0.015	0.227
HDL-C/(mmol·L^-1)	Plaque non-progression	1.09 (0.93, 1.30)	1.11 (0.93, 1.36)	1.11 (0.96, 1.33)	0.09 (0.06, 0.14)	8.54 (5.61, 10.83)
	Plaque progression	1.02 (0.92, 1.17)	1.13 (0.94, 1.24)	1.11 (0.95, 1.22)	0.11 (0.07, 0.15)	9.52 (6.38, 13.93)
	P value	0.287	0.434	0.350	0.449	0.198
Non-HDL-C/(mmol·L^-1)	Plaque non-progression	2.51 (2.08, 3.01)	2.14 (1.86, 2.56)	2.16 (1.97, 2.65)	0.43 (0.15, 0.78)	19.99 (7.34, 32.99)
	Plaque progression	2.87 (2.28, 3.89)	2.37 (1.99, 2.88)	2.50 (1.99, 3.00)	0.61 (0.30, 0.89)	21.29 (14.14, 37.83)
	P value	0.085	0.044	0.036	0.082	0.214
LDL-C/(mmol·L^-1)	Plaque non-progression	2.06 (1.65, 2.52)	1.72 (1.38, 2.11)	1.73 (1.42, 2.19)	0.29 (0.15, 0.65)	20.23 (8.72, 32.19)
	Plaque progression	2.18 (1.59, 3.29)	1.81 (1.54, 2.20)	1.84 (1.53, 2.38)	0.53 (0.25, 0.81)	25.57 (15.41, 42.34)
	P value	0.366	0.175	0.150	0.022	0.057
RLP-C/(mmol·L^-1)	Plaque non-progression	0.46 (0.35, 0.57)	0.42 (0.29, 0.49)	0.45 (0.30, 0.50)	0.13 (0.07, 0.19)	35.48 (20.05, 49.81)
	Plaque progression	0.61 (0.47, 0.76)	0.50 (0.37, 0.65)	0.52 (0.39, 0.63)	0.18 (0.12, 0.23)	33.07 (26.02, 41.53)
	P value	0.005	0.016	0.016	0.044	0.882
Lp(a)/(g·L^-1)	Plaque non-progression	0.16 (0.06, 0.32)	0.13 (0.06, 0.32)	0.13 (0.06, 0.32)	0.04 (0.02, 0.06)	23.59 (15.71, 41.61)
	Plaque progression	0.12 (0.08, 0.36)	0.12 (0.05, 0.41)	0.12 (0.05, 0.39)	0.03 (0.02, 0.08)	21.59 (10.89, 40.54)
	P value	0.807	0.913	0.886	0.936	0.446
ApoA-1/(g·L^-1)	Plaque non-progression	1.25 (1.08, 1.40)	1.29 (1.10, 1.46)	1.30 (1.11, 1.44)	0.11 (0.06, 0.16)	8.57 (4.98, 11.48)
	Plaque progression	1.22 (1.09, 1.32)	1.28 (1.10, 1.40)	1.27 (1.10, 1.39)	0.09 (0.05, 0.15)	7.29 (4.62, 10.80)
	P value	0.702	0.865	0.664	0.462	0.529
ApoB/(g·L^-1)	Plaque non-progression	0.68 (0.59, 0.82)	0.62 (0.54, 0.73)	0.63 (0.55, 0.73)	0.09 (0.05, 0.14)	15.04 (9.43, 20.47)
	Plaque progression	0.81 (0.64, 0.99)	0.71 (0.62, 0.85)	0.72 (0.62, 0.84)	0.12 (0.06, 0.23)	18.12 (7.90, 29.51)
	P value	0.047	0.021	0.021	0.116	0.387
ApoE/(mg·L^-1)	Plaque non-progression	3.55 (3.10, 4.10)	3.45 (3.29, 3.76)	3.52 (3.27, 3.92)	0.33 (0.21, 0.51)	9.62 (6.15, 14.81)
	Plaque progression	3.95 (3.55, 4.60)	3.69 (3.27, 4.24)	3.74 (3.36, 4.31)	0.54 (0.23, 0.77)	13.87 (6.43, 20.68)
	P value	0.015	0.153	0.118	0.110	0.146

Variable	Group	Baseline	Follow-up
Variable	Group	Baseline	Time-averaged	Mean	SD	CV
HbA1c/%	Plaque non-progression	6.00 (5.60, 6.47)	6.12 (5.71, 6.44)	6.08 (5.71, 6.71)	0.21 (0.13, 0.35)	3.69 (2.33, 5.66)
	Plaque progression	6.05 (5.70, 6.75)	6.09 (5.74, 6.64)	6.09 (5.74, 6.79)	0.23 (0.14, 0.44)	4.17 (2.24, 6.27)
	P value	0.685	0.715	0.784	0.769	0.691
TC/(mmol·L^-1)	Plaque non-progression	3.70 (3.21, 4.40)	3.36 (2.95, 3.81)	3.38 (2.96, 3.88)	0.35 (0.18, 0.74)	11.38 (6.47, 21.09)
	Plaque progression	3.83 (3.24, 5.02)	3.57 (3.07, 4.01)	3.65 (3.12, 4.15)	0.57 (0.40, 0.89)	15.23 (10.51, 24.96)
	P value	0.268	0.198	0.220	0.018	0.055
TAG/(mmol·L^-1)	Plaque non-progression	1.27 (0.97, 1.59)	1.26 (0.92, 1.50)	1.26 (0.92, 1.50)	0.20 (0.10, 0.35)	19.51 (8.86, 28.66)
	Plaque progression	1.73 (1.21, 2.15)	1.50 (1.22, 1.93)	1.50 (1.26, 1.95)	0.31 (0.21, 0.54)	20.71 (15.42, 34.00)
	P value	0.009	0.010	0.008	0.015	0.227
HDL-C/(mmol·L^-1)	Plaque non-progression	1.09 (0.93, 1.30)	1.11 (0.93, 1.36)	1.11 (0.96, 1.33)	0.09 (0.06, 0.14)	8.54 (5.61, 10.83)
	Plaque progression	1.02 (0.92, 1.17)	1.13 (0.94, 1.24)	1.11 (0.95, 1.22)	0.11 (0.07, 0.15)	9.52 (6.38, 13.93)
	P value	0.287	0.434	0.350	0.449	0.198
Non-HDL-C/(mmol·L^-1)	Plaque non-progression	2.51 (2.08, 3.01)	2.14 (1.86, 2.56)	2.16 (1.97, 2.65)	0.43 (0.15, 0.78)	19.99 (7.34, 32.99)
	Plaque progression	2.87 (2.28, 3.89)	2.37 (1.99, 2.88)	2.50 (1.99, 3.00)	0.61 (0.30, 0.89)	21.29 (14.14, 37.83)
	P value	0.085	0.044	0.036	0.082	0.214
LDL-C/(mmol·L^-1)	Plaque non-progression	2.06 (1.65, 2.52)	1.72 (1.38, 2.11)	1.73 (1.42, 2.19)	0.29 (0.15, 0.65)	20.23 (8.72, 32.19)
	Plaque progression	2.18 (1.59, 3.29)	1.81 (1.54, 2.20)	1.84 (1.53, 2.38)	0.53 (0.25, 0.81)	25.57 (15.41, 42.34)
	P value	0.366	0.175	0.150	0.022	0.057
RLP-C/(mmol·L^-1)	Plaque non-progression	0.46 (0.35, 0.57)	0.42 (0.29, 0.49)	0.45 (0.30, 0.50)	0.13 (0.07, 0.19)	35.48 (20.05, 49.81)
	Plaque progression	0.61 (0.47, 0.76)	0.50 (0.37, 0.65)	0.52 (0.39, 0.63)	0.18 (0.12, 0.23)	33.07 (26.02, 41.53)
	P value	0.005	0.016	0.016	0.044	0.882
Lp(a)/(g·L^-1)	Plaque non-progression	0.16 (0.06, 0.32)	0.13 (0.06, 0.32)	0.13 (0.06, 0.32)	0.04 (0.02, 0.06)	23.59 (15.71, 41.61)
	Plaque progression	0.12 (0.08, 0.36)	0.12 (0.05, 0.41)	0.12 (0.05, 0.39)	0.03 (0.02, 0.08)	21.59 (10.89, 40.54)
	P value	0.807	0.913	0.886	0.936	0.446
ApoA-1/(g·L^-1)	Plaque non-progression	1.25 (1.08, 1.40)	1.29 (1.10, 1.46)	1.30 (1.11, 1.44)	0.11 (0.06, 0.16)	8.57 (4.98, 11.48)
	Plaque progression	1.22 (1.09, 1.32)	1.28 (1.10, 1.40)	1.27 (1.10, 1.39)	0.09 (0.05, 0.15)	7.29 (4.62, 10.80)
	P value	0.702	0.865	0.664	0.462	0.529
ApoB/(g·L^-1)	Plaque non-progression	0.68 (0.59, 0.82)	0.62 (0.54, 0.73)	0.63 (0.55, 0.73)	0.09 (0.05, 0.14)	15.04 (9.43, 20.47)
	Plaque progression	0.81 (0.64, 0.99)	0.71 (0.62, 0.85)	0.72 (0.62, 0.84)	0.12 (0.06, 0.23)	18.12 (7.90, 29.51)
	P value	0.047	0.021	0.021	0.116	0.387
ApoE/(mg·L^-1)	Plaque non-progression	3.55 (3.10, 4.10)	3.45 (3.29, 3.76)	3.52 (3.27, 3.92)	0.33 (0.21, 0.51)	9.62 (6.15, 14.81)
	Plaque progression	3.95 (3.55, 4.60)	3.69 (3.27, 4.24)	3.74 (3.36, 4.31)	0.54 (0.23, 0.77)	13.87 (6.43, 20.68)
	P value	0.015	0.153	0.118	0.110	0.146

IVUS parameter	Time point	Lesion non-progression group (n=81)	Lesion progression group (n=65)	P value
Reference lumen area/mm²	BL	10.30 (7.46, 13.43)	11.25 (7.45, 15.29)	0.156
	FU	9.25 (6.96, 11.86)	7.94 (6.12, 12.70)	0.292
	Δ	-0.48 (-1.71, 0.38)	-2.00 (-3.83, -0.46)	<0.001
Reference EEM-CSA/mm²	BL	14.96 (11.21, 19.01)	15.40 (10.87, 20.45)	0.627
	FU	14.35 (10.53, 17.29)	13.99 (9.73, 18.00)	0.953
	Δ	-0.56 (-1.73, 0.04)	-0.90 (-2.83, -0.03)	0.127
Reference lumen diameter/mm	BL	4.37 (3.78, 4.93)	4.43 (3.72, 5.10)	0.697
	FU	4.27 (3.66, 4.69)	4.22 (3.47, 4.79)	0.887
	Δ	-0.08 (-0.28, 0.00)	-0.19 (-0.38, -0.03)	0.072
MLA/mm²	BL	5.80 (4.49, 8.29)	7.30 (4.04, 9.92)	0.210
	FU	5.60 (4.28, 8.09)	5.11 (3.53, 7.27)	0.144
	Δ	-0.13 (-0.75, 0.37)	-1.77 (-2.92, -0.54)	<0.001
EEM-CSA at MLA/mm²	BL	14.31 (10.46, 17.33)	14.12 (9.80, 19.14)	0.931
	FU	13.10 (9.59, 15.47)	12.99 (9.86, 18.03)	0.884
	Δ	-0.59 (-1.97, 0.12)	-0.39 (-2.05, 0.31)	0.663
MLD/mm	BL	2.71 (2.39, 3.25)	3.15 (2.27, 3.55)	0.145
	FU	2.67 (2.42, 3.22)	2.55 (2.12, 3.04)	0.091
	Δ	-0.02 (-0.20, 0.10)	-0.42 (-0.70, -0.15)	<0.001
TAV/mm³	BL	43.59 (24.95, 62.60)	29.94 (18.18, 44.91)	0.008
	FU	42.79 (20.63, 66.88)	45.61 (27.13, 64.83)	0.381
	Δ	-2.23 (-9.18, 2.55)	11.93 (6.02, 17.54)	<0.001
TAVnorm/mm³	BL	41.81 (32.41, 51.73)	31.50 (20.14, 43.74)	<0.001
	FU	38.05 (25.60, 51.21)	46.04 (32.70, 56.98)	0.079
	Δ	-2.07 (-7.74, 2.47)	10.82 (5.55, 18.17)	<0.001
PAV/%	BL	45.21 (37.49, 51.80)	34.70 (23.61, 44.55)	<0.001
	FU	41.36 (33.84, 48.96)	48.84 (38.81, 55.84)	0.003
	Δ	-2.01 (-7.04, 1.85)	10.31 (7.23, 15.96)	<0.001
RI	BL	0.96 (0.89, 1.00)	0.93 (0.87, 0.98)	0.082
	FU	0.95 (0.88, 1.00)	0.95 (0.89, 1.01)	0.487
	Δ	0.01 (-0.05, 0.05)	0.04 (-0.03, 0.10)	0.035