Certain lipoprotein particles may increase risk for MI, PAD in women
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Triglyceride-rich lipoprotein cholesterol was strongly linked to future peripheral artery disease and MI events in women, according to a study published in the Journal of the American College of Cardiology.
The study also found that small-dense LDL was strongly associated with MI.
“Our data are relevant to understanding residual cardiovascular risk beyond LDL-C and to drug development programs exploring novel targets for atherosclerosis prevention,” Edward K. Duran, MD, MSc, postdoctoral research fellow in cardiovascular epidemiology at Brigham and Women’s Hospital and Harvard Medical School, and colleagues wrote.
Women’s Health Study
Researchers analyzed data from 480 women from the Women’s Health Study with incident total CVD and a subcohort of 496 women who were frequency matches on smoking status and age. Measurements taken at baseline included triglyceride-rich lipoprotein cholesterol and small-dense LDL.
Risk associations were assessed for total CVD (defined as ischemic stroke, MI, CVD death and PAD), individual outcomes (ischemic stroke, MI and PAD), and coronary and cerebrovascular disease (ischemic stroke, MI and CVD death).
The risk for the composite outcomes increased across quartiles of small-dense LDL and triglyceride-rich lipoprotein cholesterol. Triglyceride-rich lipoprotein cholesterol was significantly linked to PAD (HR = 2.58; 95% CI, 1.18-5.63) and MI (HR = 3.05; 95% CI, 1.46-6.39). Small-dense LDL was only significantly associated with MI (HR = 3.71; 95% CI, 1.59-8.63).
Researchers observed a weak association between both markers and ischemic stroke.
Similar association patterns were detected in patients with low atherogenic particle concentrations for triglyceride-rich lipoproteins, particularly apolipoprotein B less than 100 mg/dL. Continuous exposures also had similar association patterns.
“The cholesterol content of triglyceride-rich lipoprotein particles appears to confer atherosclerotic risk mainly through MI and PAD events, even among subjects with clinically normal total ApoB particle levels,” Duran and colleagues wrote. “Recommendations in future lipid guidelines to measure triglyceride rich lipoprotein-C when ApoB is within normal limits may help to identify subjects who are at persistent risk of future atherosclerotic events. The cholesterol content of small-dense LDL particles, however, appears to influence the development of total cardiovascular events largely through increased risk of fatal and nonfatal MI.”
Familiarity with assays
In a related editorial, Gerald F. Watts, DSc, PhD, MD, senior academic in the School of Medicine and Pharmacology at the University of Western Australia, and Dick C. Chan, PhD, senior research fellow in the faculty of health and medical sciences at The University of Western Australia in Perth, wrote: “The clinical success of these assays will ... depend on costs and physicians’ familiarity with their use. Calculated non-HDL-C and remnant cholesterol are least expensive and may be preferred for pragmatic reasons. However, ApoB is recommended as the most precise metric for assessing atherogenic lipoproteins and is superior to non-HDL-C in detecting familial combined hyperlipidemia and dysbetalipoproteinemia due to E2/E2 homozygosity.” – by Darlene Dobkowski
Disclosures: The study was supported by the NIH with additional funding from Denka-Seiken and Kowa Research Institute for triglyceride-rich lipoprotein and small-dense LDL measurements. Duran and Chan report no relevant financial disclosures. Watts reports he received honoraria or research grants from Amgen, Arrowhead, Gemphire, Genfit, Kowa, Regeneron and Sanofi. Please see the study for all other authors’ relevant financial disclosures.
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Duran EK, et al. J Am Coll Cardiol. 2020;doi:10.1016/j.jacc.2020.02.059.
Watts GF, et al. J Am Coll Cardiol. 2020;doi:10.1016/j.jacc.2020.03.032.
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