Relationship Between Small Dense Low Density Lipoprotein and Cardiovascular Events in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Overview

Journal BMC Cardiovasc Disord

Publisher Biomed Central

Specialty Cardiology & Vascular Diseases

Date 2021 Apr 13

PMID 33845772

Citations 6

Authors

Jianwei Zhang

Lingjie He

Affiliations

Soon will be listed here.

Abstract

Background: Residual risk remained significant despite effective low density lipoprotein cholesterol (LDL-C) lowering treatment. Small dense low density lipoprotein cholesterol (sdLDL-C) as part of LDL-C has been found to be predictor of coronary heart disease (CHD) and cardiovascular (CV) events in patients with stable CHD independently of LDL-C. However, to date, few studies have explored the role of sdLDL-C in patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI). Accordingly, this study aimed to evaluate the association of sdLDL-C with CV events in patients with ACS undergoing PCI.

Methods: Patients hospitalized with ACS undergoing PCI were enrolled and followed up for 18 months. The risk of sdLDL-C for CV events was compared according to sdLDL-C quartiles. The primary outcome was major cardiovascular and cerebrovascular adverse events (MACCE), which was the composite of all cause of death, nonfatal myocardial infarction (MI), nonfatal stroke or unplanned repeat revascularization. A Cox proportional hazards regression model was performed to estimate the risk of CV events. Subgroup analysis according to diabetes status and LDL-C were performed separately for MACCE.

Results: A total of 6092 patients were included in the analysis (age: 60.2 ± 10.13 years, male: 75.3%, BMI: 25.9 ± 3.33 kg/m, dyslipidemia: 74.1% and diabetes: 44.5%). During 18 months of follow-up, 320 (5.2%) incident CV events occurred. Compared to the lowest sdLDL-C quartile group, patients in the highest quartile had a greater risk of CV events after multivariable adjustment (HR 1.92; 95% CI 1.37-2.70). In addition, it was mainly due to the increase of unplanned repeat revascularization. In the subgroup analyses, significant association was observed regardless of level of LDL-C and diabetes status.

Conclusions: Patients with elevated sdLDL-C have a higher risk of CV events in Chinese patients with ACS undergoing PCI, providing additional value for better risk assessment.

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References

Jin J, Zhang H, Cao Y, Liu H, Hua Q, Li Y . Association of small dense low-density lipoprotein with cardiovascular outcome in patients with coronary artery disease and diabetes: a prospective, observational cohort study. Cardiovasc Diabetol. 2020; 19(1):45. PMC: 7118853. DOI: 10.1186/s12933-020-01015-6. View

Ai M, Otokozawa S, Asztalos B, Ito Y, Nakajima K, White C . Small dense LDL cholesterol and coronary heart disease: results from the Framingham Offspring Study. Clin Chem. 2010; 56(6):967-76. PMC: 3791882. DOI: 10.1373/clinchem.2009.137489. View

James P, Oparil S, Carter B, Cushman W, Dennison-Himmelfarb C, Handler J . 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2013; 311(5):507-20. DOI: 10.1001/jama.2013.284427. View

Cosentino F, Grant P, Aboyans V, Bailey C, Ceriello A, Delgado V . 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J. 2019; 41(2):255-323. DOI: 10.1093/eurheartj/ehz486. View

Tsai M, Steffen B, Guan W, McClelland R, Warnick R, McConnell J . New automated assay of small dense low-density lipoprotein cholesterol identifies risk of coronary heart disease: the Multi-ethnic Study of Atherosclerosis. Arterioscler Thromb Vasc Biol. 2013; 34(1):196-201. PMC: 4211254. DOI: 10.1161/ATVBAHA.113.302401. View

Li G, Wu H, Wu X, Cao Z, Tu Y, Ma Y . Small dense low density lipoprotein-cholesterol and cholesterol ratios to predict arterial stiffness progression in normotensive subjects over a 5-year period. Lipids Health Dis. 2018; 17(1):27. PMC: 5810050. DOI: 10.1186/s12944-018-0671-2. View

Zhao X, Sun D, Xu R, Guo Y, Zhu C, Wu N . Low-density lipoprotein-associated variables and the severity of coronary artery disease: an untreated Chinese cohort study. Biomarkers. 2018; 23(7):647-653. DOI: 10.1080/1354750X.2018.1474256. View

McNamara J, Small D, Li Z, Schaefer E . Differences in LDL subspecies involve alterations in lipid composition and conformational changes in apolipoprotein B. J Lipid Res. 1996; 37(9):1924-35. View

Krychtiuk K, Kastl S, Pfaffenberger S, Lenz M, Hofbauer S, Wonnerth A . Association of small dense LDL serum levels and circulating monocyte subsets in stable coronary artery disease. PLoS One. 2015; 10(4):e0123367. PMC: 4388574. DOI: 10.1371/journal.pone.0123367. View

10.

Shen H, Xu L, Lu J, Hao T, Ma C, Yang H . Correlation between small dense low-density lipoprotein cholesterol and carotid artery intima-media thickness in a healthy Chinese population. Lipids Health Dis. 2015; 14:137. PMC: 4625741. DOI: 10.1186/s12944-015-0143-x. View

11.

Hsu S, Jang M, Torng P, Su T . Positive Association Between Small Dense Low-Density Lipoprotein Cholesterol Concentration and Biomarkers of Inflammation, Thrombosis, and Prediabetes in Non-Diabetic Adults. J Atheroscler Thromb. 2018; 26(7):624-635. PMC: 6629751. DOI: 10.5551/jat.43968. View

12.

Qi Y, Liu J, Wang W, Wang M, Zhao F, Sun J . High sdLDL Cholesterol can be Used to Reclassify Individuals with Low Cardiovascular Risk for Early Intervention: Findings from the Chinese Multi-Provincial Cohort Study. J Atheroscler Thromb. 2019; 27(7):695-710. PMC: 7406409. DOI: 10.5551/jat.49841. View

13.

Santos H, Earnest C, Tinsley G, Izidoro L, Macedo R . Small dense low-density lipoprotein-cholesterol (sdLDL-C): Analysis, effects on cardiovascular endpoints and dietary strategies. Prog Cardiovasc Dis. 2020; 63(4):503-509. DOI: 10.1016/j.pcad.2020.04.009. View

14.

Arai H, Kokubo Y, Watanabe M, Sawamura T, Ito Y, Minagawa A . Small dense low-density lipoproteins cholesterol can predict incident cardiovascular disease in an urban Japanese cohort: the Suita study. J Atheroscler Thromb. 2012; 20(2):195-203. DOI: 10.5551/jat.14936. View

15.

Thygesen K, Alpert J, Jaffe A, Chaitman B, Bax J, Morrow D . Fourth Universal Definition of Myocardial Infarction (2018). Circulation. 2018; 138(20):e618-e651. DOI: 10.1161/CIR.0000000000000617. View

16.

Hsu H, Hsu P, Cheng M, Ito Y, Kanda E, Schaefer E . Lipoprotein Subfractions and Glucose Homeostasis in Prediabetes and Diabetes in Taiwan. J Atheroscler Thromb. 2019; 26(10):890-914. PMC: 6800394. DOI: 10.5551/jat.48330. View

17.

Thongtang N, Diffenderfer M, Ooi E, Barrett P, Turner S, Le N . Metabolism and proteomics of large and small dense LDL in combined hyperlipidemia: effects of rosuvastatin. J Lipid Res. 2017; 58(7):1315-1324. PMC: 5496030. DOI: 10.1194/jlr.M073882. View

18.

Roffi M, Patrono C, Collet J, Mueller C, Valgimigli M, Andreotti F . 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment.... Eur Heart J. 2015; 37(3):267-315. DOI: 10.1093/eurheartj/ehv320. View

19.

Nozue T, Michishita I, Ishibashi Y, Ito S, Iwaki T, Mizuguchi I . Small dense low-density lipoprotein cholesterol is a useful marker of metabolic syndrome in patients with coronary artery disease. J Atheroscler Thromb. 2007; 14(4):202-7. DOI: 10.5551/jat.e507. View

20.

Neumann F, Sousa-Uva M, Ahlsson A, Alfonso F, Banning A, Benedetto U . 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2018; 40(2):87-165. DOI: 10.1093/eurheartj/ehy394. View