Impact of Cholesterol Control on Coronary Lesion Development in Flow-Disturbed Segments Identified by Coronary Acoustic Action Map

Background: Intimal injury and low-density lipoprotein cholesterol (LDL-C) are well-established contributors to atherosclerotic plaque development. Coronary Acoustic Action Map (CAAM) suggests that acoustic retrograde pressure waves from the water hammer phenomenon may identify regions prone to endothelial injury. However, the impact of cholesterol in these high-risk regions remains unclear. We aim to investigate the correlation between LDL-C and lesion severity in flow-disturbed regions identified by CAAM. Methods: A cross-sectional study of 29 patients with unstable angina and no history of percutaneous coronary intervention or coronary artery bypass grafting. All patients underwent coronary angiography and were stratified by LDL-C levels as optimal (≤70 mg/dL) and suboptimal (>70 mg/dL) groups. Lesion severity classified as: no lesion (0%), mild (<30%), moderate (30–70%), or severe (>70%) luminal narrowing in four flow-disturbed regions (1R–4R). The correlation between lesion severity and LDL-C was assessed using Fisher's exact test across all regions. Result: Among 29 patients (16 with optimal LDL-C ≤70 mg/dL, 13 with suboptimal LDL-C >70 mg/dL), lesion severity was assessed across four regions (1R–4R). In region 1R, mild to severe lesions were present in both groups, but no significant association was found (p = 0.852). Regions 2R, 3R, and 4R showed predominantly no or mild lesions in both groups, with no significant differences observed (p > 0.05). Overall, lesion severity did not differ significantly between LDL-C groups across all regions. Conclusion: Although findings were not significant, likely due to small sample size, the trend toward greater lesion burden in the suboptimal LDL-C group—especially in region 1R—warrants further study.