{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T20:42:19Z","timestamp":1757623339238,"version":"3.44.0"},"reference-count":22,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T00:00:00Z","timestamp":1757376000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Glucocorticoids (GCs) exhibit metabolic risks that may accelerate atherosclerosis. However, their <jats:italic>in vivo<\/jats:italic> effects on atherosclerotic plaques remain poorly understood. This case highlights the perilous interplay between chronic GC use and plaque vulnerability during dose reduction.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case summary<\/jats:title><jats:p>A 51-year-old male with immune nephritis, chronic kidney disease (CKD), and poorly controlled hypertension presented with unstable angina. Coronary angiography revealed multivessel disease [70% stenosis in the proximal left anterior descending artery (LAD) and 90% in the posterior descending artery]. Initial treatment included angioplasty with a drug-coated balloon in the posterior descending artery, dual antiplatelet therapy, statins, and prednisone (10\u2005mg\/day). Seven months later, after self-reducing GCs to 5\u2005mg\/day, he suffered an acute myocardial infarction due to LAD plaque rupture, confirmed by optical coherence tomography (OCT) showing fibrolipid-rich plaques, deep calcifications, and minimal lumen area (0.67\u2005mm<jats:sup>2<\/jats:sup>). Emergency stenting was performed to stabilize the patient, with no recurrence at 3-month follow-up.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>This case underscores the mechanistic duality of GCs. Chronic GC therapy suppresses pro-inflammatory cytokines and macrophage activity, stabilizing plaques by reducing oxidized LDL uptake. However, abrupt tapering may trigger rebound vascular inflammation, destabilizing high-risk lesions. OCT imaging proved critical in identifying vulnerable plaque morphology, emphasizing its role in guiding urgent interventions.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2025.1625491","type":"journal-article","created":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T06:03:08Z","timestamp":1757397788000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Coronary plaque rupture following glucocorticoid tapering in a high-risk CAD patient with immune nephritis: mechanistic insights and clinical implications"],"prefix":"10.3389","volume":"12","author":[{"given":"Jianxin","family":"Weng","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fushi","family":"Piao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruihui","family":"Lai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wenwen","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shuai","family":"Sun","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tan","family":"Xu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,9,9]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1823","DOI":"10.1016\/j.jacc.2019.08.1017","article-title":"Chronic kidney disease and coronary artery disease: JACC state-of-the-art review","volume":"74","author":"Sarnak","year":"2019","journal-title":"J Am Coll Cardiol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"200253","DOI":"10.1016\/j.ijcrp.2024.200253","article-title":"Premature coronary heart disease complicated with hypertension in hospitalized patients: incidence, risk factors, cardiovascular-related comorbidities and prognosis, 2008\u20132018","volume":"21","author":"Li","year":"2024","journal-title":"Int J Cardiol Cardiovasc Risk Prev"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1090","DOI":"10.1056\/NEJMc2024023","article-title":"Management of coronary disease in patients with advanced kidney disease","volume":"383","author":"Afsar","year":"2020","journal-title":"N Engl J Med"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1093\/ehjcvp\/pvae099","article-title":"Cardiovascular disease and cardiovascular pharmacotherapy: the challenges and the research continue","volume":"11","author":"Lewis","year":"2025","journal-title":"Eur Heart J Cardiovasc Pharmacother"},{"key":"B5","doi-asserted-by":"publisher","first-page":"815","DOI":"10.2215\/CJN.12991117","article-title":"Glucocorticoids in the treatment of glomerular diseases: pitfalls and pearls","volume":"13","author":"Ponticelli","year":"2018","journal-title":"Clin J Am Soc Nephrol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"7622","DOI":"10.3390\/ijms22147622","article-title":"Glucocorticoids: fuelling the fire of atherosclerosis or therapeutic extinguishers?","volume":"22","author":"MacLeod","year":"2021","journal-title":"Int J Mol Sci"},{"key":"B7","first-page":"223","article-title":"Nephritis and the risk of acute myocardial infarction in patients with systemic lupus erythematosus","volume":"28","author":"Wells","year":"2010","journal-title":"Clin Exp Rheumatol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1529","DOI":"10.1042\/CS20171505","article-title":"Defining the role of glucocorticoids in inflammation","volume":"132","author":"Ronchetti","year":"2018","journal-title":"Clin Sci"},{"key":"B9","doi-asserted-by":"publisher","first-page":"119180","DOI":"10.1016\/j.atherosclerosis.2025.119180","article-title":"Reprogramming human macrophages in symptomatic carotid stenosis: stabilisation of atherosclerotic carotid plaques","volume":"404","author":"Kocsy","year":"2025","journal-title":"Atherosclerosis"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1197","DOI":"10.1093\/eurheartj\/ehab067","article-title":"Glucocorticoids in patients with immune-mediated inflammatory diseases: a neglected cardiovascular risk factor","volume":"42","author":"Galiuto","year":"2021","journal-title":"Eur Heart J"},{"key":"B11","doi-asserted-by":"publisher","first-page":"623","DOI":"10.3390\/ijms22020623","article-title":"Molecular mechanisms of glucocorticoid-induced insulin resistance","volume":"22","author":"Beaupere","year":"2021","journal-title":"Int J Mol Sci"},{"key":"B12","doi-asserted-by":"publisher","first-page":"671","DOI":"10.7196\/SAMJ.7979","article-title":"The influence of glucocorticoids on lipid and lipoprotein metabolism and atherosclerosis","volume":"104","author":"Ross","year":"2014","journal-title":"S Afr Med J"},{"key":"B13","doi-asserted-by":"publisher","first-page":"132","DOI":"10.1093\/rheumatology\/keaa209","article-title":"Glucocorticoid use is associated with an increased risk of hypertension","volume":"60","author":"Costello","year":"2021","journal-title":"Rheumatology"},{"key":"B14","doi-asserted-by":"publisher","first-page":"414","DOI":"10.1016\/j.atherosclerosis.2013.11.076","article-title":"Corticosterone accelerates atherosclerosis in the apolipoprotein E-deficient mouse","volume":"232","author":"Okutsu","year":"2014","journal-title":"Atherosclerosis"},{"key":"B15","doi-asserted-by":"publisher","first-page":"217","DOI":"10.1016\/j.cardiores.2004.07.006","article-title":"Does altered glucocorticoid homeostasis increase cardiovascular risk?","volume":"64","author":"Girod","year":"2004","journal-title":"Cardiovasc Res"},{"key":"B16","doi-asserted-by":"publisher","first-page":"e1003432","DOI":"10.1371\/journal.pmed.1003432","article-title":"Dose-dependent oral glucocorticoid cardiovascular risks in people with immune-mediated inflammatory diseases: a population-based cohort study","volume":"17","author":"Pujades-Rodriguez","year":"2020","journal-title":"PLoS Med"},{"key":"B17","doi-asserted-by":"publisher","first-page":"817","DOI":"10.1038\/s41419-024-07166-8","article-title":"Inflammation in atherosclerosis: pathophysiology and mechanisms","volume":"15","author":"Ajoolabady","year":"2024","journal-title":"Cell Death Dis"},{"key":"B18","doi-asserted-by":"publisher","first-page":"1197","DOI":"10.1056\/NEJMe1709904","article-title":"Targeting inflammation in coronary artery disease","volume":"377","author":"Harrington","year":"2017","journal-title":"N Engl J Med"},{"key":"B19","doi-asserted-by":"publisher","first-page":"1119","DOI":"10.1056\/NEJMoa1707914","article-title":"Antiinflammatory therapy with canakinumab for atherosclerotic disease","volume":"377","author":"Ridker","year":"2017","journal-title":"N Engl J Med"},{"key":"B20","doi-asserted-by":"publisher","first-page":"1361","DOI":"10.1016\/j.jcin.2025.04.044","article-title":"Long-term prognostic impact of OCT-derived high-risk plaque features: extended follow-up of the CLIMA study","volume":"18","author":"Biccire","year":"2025","journal-title":"JACC Cardiovasc Interv"},{"key":"B21","doi-asserted-by":"publisher","first-page":"176","DOI":"10.1089\/met.2019.0115","article-title":"High-risk atherosclerosis and metabolic phenotype: the roles of ectopic adiposity, atherogenic dyslipidemia, and inflammation","volume":"18","author":"Lechner","year":"2020","journal-title":"Metab Syndr Relat Disord"},{"key":"B22","doi-asserted-by":"publisher","first-page":"998","DOI":"10.1136\/ard-2023-225369","article-title":"Risk of flare and damage accrual after tapering glucocorticoids in modified serologically active clinically quiescent patients with systemic lupus erythematosus: a multinational observational cohort study","volume":"83","author":"Katsumata","year":"2024","journal-title":"Ann Rheum Dis"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2025.1625491\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T06:03:14Z","timestamp":1757397794000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2025.1625491\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,9]]},"references-count":22,"alternative-id":["10.3389\/fcvm.2025.1625491"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2025.1625491","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,9]]},"article-number":"1625491"}}