Leukocyte Telomere Length Shortening Implies Plaque Instability and Major Adverse Cardiovascular Events in Patients With Angiographically Intermediate Lesions

Alian Zhang; Li Fan; Xiaolu Bao; Zuojun Xu; Zhaofang Yin; Yang Zhuo; Junfeng Zhang; Jun Gu; Alex C Y Chang; Yuqi Fan; Changqian Wang

doi:10.3389/fcvm.2021.812363

Leukocyte Telomere Length Shortening Implies Plaque Instability and Major Adverse Cardiovascular Events in Patients With Angiographically Intermediate Lesions

Front Cardiovasc Med. 2022 Jan 21:8:812363. doi: 10.3389/fcvm.2021.812363. eCollection 2021.

Authors

Alian Zhang¹, Li Fan¹, Xiaolu Bao^{1

2}, Zuojun Xu¹, Zhaofang Yin¹, Yang Zhuo¹, Junfeng Zhang¹, Jun Gu¹, Alex C Y Chang^{1

2}, Yuqi Fan¹, Changqian Wang¹

Affiliations

¹ Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.
² Shanghai Institute of Precision Medicine, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.

Abstract

Background: Telomere shortening, an indicator of aging, is associated with age-related diseases. This study aims to investigate the association between leukocyte telomere length (LTL) and thin-capped fibroatheromata (TCFA) and the impact of using LTL cutoff to determine the incidence of major adverse cardiovascular events (MACEs) in patients with angiographically intermediate coronary lesions.

Methods: This was a signal-center retrospective study focusing on patients who underwent coronary angiography and optical coherence tomography (OCT). The degree of coronary stenosis was assessed by angiography. The presence of TCFA was determined by OCT imaging. A total of 156 patients with angiographically intermediate coronary lesions were enrolled.

Results: Leukocyte telomere lengths were significantly shorter in the TCFA group compared with non-TCFA group [11.95 (10.56, 15.21) kb vs. 13.81 (12.06, 16.11) kb, p = 0.003]. The short-LTL group and long-LTL group were divided according to the optimal cut-off value which was determined by the receiver operating characteristic (ROC) curve analysis. Logistic regression model revealed that short-LTL was independently associated with TCFA incidence (odds ratio [OR] 4.387, 95% CI: 1.902-10.120, p = 0.001) after adjusting for confounding factors. Over a 24-months follow-up, the MACE incidence among patients with short-LTL was significantly higher than those in the long-LTL group (12.5 vs. 2.0%, p = 0.006 by log-rank test). Multivariable cox regression analysis indicated that short-LTL (hazard ratio [HR] 9.716, 95% CI: 1.995-47.319, p = 0.005) was an independent prognostic factor of MACE incidence in angiographically intermediate coronary lesions patients.

Conclusions: Short-LTL was independently associated with the incidence of TCFA and may serve as a prognostic factor for MACE risk on top of conventional risk factors.

Keywords: angiographically intermediate coronary lesion; leukocyte telomere length; major adverse cardiovascular events (MACE); plaque instability; thin-capped fibroatheromata.