Abstract
Pathogenesis of coronary artery disease (CAD) is multi-factorial and several conventional risk factors have been ascribed; LDL-C being one of the important risk factor. However Indian population studies with established CAD often show LDL levels within normal range in patients with proven CAD. We hypothesized that Small dense low density lipoprotein (sdLDL) being more atherogenic might correlate more strongly to the occurrence and severity of CAD. The aim of the study was to evaluate the association between serum small dense LDL level and angiographically documented coronary artery disease. This is a cross sectional case control study in which sdLDL were measured in 126 patients with CAD and in 64 patients without CAD. Total cholesterol, HDL Cholesterol, LDL cholesterol and triglycerides were measured by standard methods along with other traditional risk factors. Direct quantitative measurement of sdLDL was done by enzymatic analysis. Mean sdLDL level was higher in patients with coronary stenosis than patients without coronary stenosis (16.3 ± 6.8 vs. 10.1 ± 5.7 mg/dL respectively, (p < 0.001). There was significant correlation between mean sdLDL and severity of CAD as assessed by syntax score with mean sdLDL level in low, intermediate and high syntax score being 15.0 ± 5.8, 20.1 ± 6.7 and 22.7 ± 7.3 mg/dL respectively (p value <0.001). A cut off value of 10.02 mg/dL was associated with presence of CAD (95 % CI 0.82–0.93, p < 0.001) using ROC curve. In conclusion Indian patients with established CAD have higher sdLDL levels compared to individuals without CAD despite having comparable LDL levels.
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Smith SC, Jackson R, Pearson TA, Fuster V, Yusuf S, Faergeman O, et al. Principles for national and regional guidelines on cardiovascular disease prevention: scientific statement from the world heart and stroke forum. Circulation. 2004;109:3112–21.
Penalva RA, Huoya Mde O, Correia LC, Feitosa GS, Ladeia AM. Lipid profile and intensity of atherosclerosis disease in acute coronary syndrome. Arq Bras Cardiol. 2008;90(1):24–30.
Goel PK, Bharti BB, Pandey CM, Singh U, Tewari S, Kapoor A, et al. A tertiary care hospital-based study of conventional risk factors including lipid profile in proven coronary artery disease. Indian Heart J. 2003;55:234–40.
Mohan V, Deepa R, Rani SS, Premalatha G. Prevalence of coronary artery disease and its relationship to lipids in a selected population in South India: the Chennai Urban Population Study (CUPS No. 5). J Am Coll Cardiol. 2001;38(3):682–7.
Krauss RM. Heterogeneity of plasma low density lipoproteins and atherosclerotic risk. Curr Opin Lipidol. 1994;5:339–49.
Sacks FM, Campus H. Low density lipoprotein size and cardiovascular disease: a reappraisal. J Clin Endocrinol Metab. 2003;88:4525–32.
Koba S, Hirano T, Yoshino G, Sakai K, Sakaue T, Adachi M, Katagiri T. Remarkably high prevalence of small dense low density lipoprotein in Japanese men with coronary artery disease. Atherosclerosis. 2002;160:249–56.
Lamarche B, Tchernof A, Moorjani S, Cantin B, Dagenais GR, Lupien PJ, et al. Small dense low density lipoprotein particles as a predictor of the risk of ischemic heart disease in men. Prospective results from the Quebec cardiovascular Study. Circulation. 1997;95:69–75.
Tsai MY, Steffen BT, Guan W, McClelland RL, Warnick R, McConnell J, Hoefner DM, Remaley AT. 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. 2014;34:196–201.
Martin SS, Blaha MJ, Elshazly MB, Brinton EA, Toth PP, McEvoy JW, et al. Friedewald-estimated versus directly measured low-density lipoprotein cholesterol and treatment implications. J Am Coll Cardiol. 2013;62(8):732–9.
Meijboom WB, Van Mieghem CA, van Pelt N, Weustink A, Pugliese F, Mollet NR, et al. Comprehensive assessment of coronary artery stenoses computed tomography coronary angiography versus conventional coronary angiography and correlation with fractional flow reserve in patients with stable angina. J Am Coll Cardiol. 2008;52:636–43.
Serruys PW, Morice MC, Kappetein AP, Antonio Colombo A, Holmes DR, Mack MJ, et al. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med. 2009;360:961–72.
Kulkarni KR, Markovitz JH, Nanda NC, Segrest JP. Increased prevalence of smaller and denser LDL particles in Asian Indians. Arterioscler Thromb Vasc Biol. 1999;19:2749–55.
Abate N, Garg A, Enas EA. Physico-chemical properties of low-density lipoproteins in normolipidemic Asian Indian men. Horm Metab Res. 1995;27:326–31.
Väisänen S, Baumstark MW, Penttilä I, Bouchard C, Halonen P, Rankinen T, Berg A, Rauramaa R. Small, dense LDL particle concentration correlates with plasminogen activator inhibitor type-1 (PAI-1) activity. Thromb Haemost. 1997;78(6):1495–9.
Gohari LH, Ghassab RK, Firoozray M, Zavarehee A, Basiri HA. The association between small dense low density lipoprotein, apolipoprotein B, apolipoprotein B/apolipoprotein A1 ratio and coronary and coronary artery stenosis. Med J Islam Repub Iran. 2009;23(1):8–13.
Griffin BA, Freeman DJ, Tait GW, Thomson J, Caslake MJ, Packard CJ, et al. Role of plasma triglyceride in the regulation of plasma low density lipoprotein subfractions: relative contribution of small, dense LDL to coronary heart disease risk. Atherosclerosis. 1994;106:241–53.
Hoogeveen RC, Gaubatz JW, Sun W, Dodge RC, Crosby JR, Jiang J, Couper D, Virani SS, Kathiresan S, Boerwinkle E, Ballantyne CM. Small dense low-density lipoprotein-cholesterol concentrations predict risk for coronary heart disease: the Atherosclerosis Risk In Communities (ARIC) Study. Arterioscler Thromb Vasc Biol. 2014;34(5):1069–77.
Mohan V, Deepa R, Velmurugan K, Gokulakrishnan K. Association of small dense LDL with coronary artery disease and diabetes in urban Asian Indians—the Chennai urban rural epidemiology study (CURES-8). J Assoc Physicians India. 2005;53:95–100.
Choi CU, Seo HS, Lee EM, Shin SY, Choi UJ, Na JO, et al. Statins do not decrease small, dense low-density lipoprotein. Tex Heart Inst J. 2010;37(4):421–8.
Yoshino G, Nakano S, Matsumoto T, Murakami E, Morita T. Rosuvastatin reduces plasma small dense LDL-cholesterol predominantly in non-diabetic hypercholesterolemic patients. Pharmacol Pharm. 2012;3:72–8.
Toft-Petersen AP, Tilsted HH, Aarøe J, Rasmuseen K, Christensen T, Griffin BA, et al. Small dense LDL particles—a predictor of coronary artery disease evaluated by invasive and CT-based techniques: a case-control study. Lipids Health Dis. 2011;10:21. doi:10.1186/1476-511X-10-21.
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Goel, P.K., Ashfaq, F., Khanna, R. et al. The Association Between Small Dense Low Density Lipoprotein and Coronary Artery Disease in North Indian Patients. Ind J Clin Biochem 32, 186–192 (2017). https://doi.org/10.1007/s12291-016-0592-7
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DOI: https://doi.org/10.1007/s12291-016-0592-7