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Small dense LDL cholesterol predicts CVD events post-liver transplant

According to a study published in Hepatology, small dense LDL cholesterol independently predicted cardiovascular disease events among liver transplant recipients, according to a study published in Hepatology.

“The present study employs detailed lipoprotein sub-particles to link specific proteins with CVD outcomes using a prospective cohort and provides valuable information that can be readily incorporated into clinical practice to hopefully improve clinical outcomes,” Mohammad B. Siddiqui, MD, from the Virginia Commonwealth University, and colleagues wrote. “The generation of the atherogenic [small dense LDL cholesterol (sdLDL-C)] likely results from insulin resistance, exposure to chronic immunosuppression and fatty liver after LT.”

The researchers included 130 liver transplant recipients in the study. The primary etiologies for liver transplantation included hepatitis C, nonalcoholic steatohepatitis and alcohol-related cirrhosis. The prevalence of cardiometabolic conditions at baseline included diabetes (35%), hypertension (82%), and dyslipidemia (40%).

At baseline, sdLDL-C correlated with BMI (P = .0008) and hypertension (P = .01). It also correlated with apolipoprotein B (P < .001), very low-density lipoprotein cholesterol (VLDL-C; P = .001), and LDL size (P = .006) after multivariate adjustment.

According to the researchers, VLDL metabolism within the liver is perturbed in cases of chronic liver disease and leads to the production and secretion of large, triglyceride-laden VLDL particles that are slowly metabolized intravascularly. The altered LDL particles can result in sdLDL particles that have a lower affinity for LDL receptor and therefore spend more time in circulation, potentially leading to plaque formation.

Twenty patients experienced a CVD event after a median follow-up of 45 months, including myocardial infarction (n = 9), need for coronary revascularization (n = 8), and angina (n = 3). The researchers reported no CVD-related deaths in the cohort. Seventeen of these patients had sdLDL-C higher than 25 mg/dL at baseline.

Patients with sdLDL-C higher than 25 mg/dL at baseline were more likely to have cardiometabolic diseases. Multivariate analysis showed that a concentration higher than 25 mg/dL correlated significantly with risk for a CVD event after adjusting for obesity, hypertension, statin use, liver disease, ethnicity, and sex (HR = 4.657; 95% CI, 1.335-16.239).

“The current study provides proof of concept showing the limited utility of traditional lipid profile for risk stratifying patients,” Siddiqui and colleagues concluded. “Future studies aimed at lowering serum sdLDL-C and linking to improvement in clinical outcomes are necessary to improve CVD risk management in [liver transplant recipients].” – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.