Small, dense low-density lipoproteins as predictors of cardiovascular risk beyond traditional risk factors

The predictive role of small, dense low-density lipoproteins (LDL) is still unclear although they are a feature of the metabolic syndrome and metabolic syndrome-associated atherogenic dyslipidaemia. A total of 124 adult subjects (recruited from a larger group of subjects undergoing contrast angiography) with metabolic syndrome and without overt coronary heart disease (metabolic syndrome defined by the American Heart Association/National Heart, Lung, and Blood Institute guidelines (AHA/NHLBI)) were followed-up in order to assess clinical and biochemical predictors of cerebro- and cardiovascular events. LDL size and subclasses were measured using gradient gel electrophoresis. During the 2-year follow-up period, clinical events occurred in 25% of the study population. Univariate analysis revealed that subjects with events had increased prevalence of elevated fasting glucose, smoking, family history of coronary artery disease and higher levels of total and LDL cholesterol; in these subjects, LDL size was significantly lower owing to reduced larger subclasses and increased small, dense LDL. In multivariate analysis, low HDL cholesterol, elevated fasting glucose, elevated small, dense LDL, elevated blood pressure and smoking were identified as independent predictors of events. In conclusion, in subjects presenting with metabolic syndrome, small, dense LDL appear to have a predictive role, beyond traditional cardiovascular risk factors.

Abstract

Keywords:
CAD – Cardiovascular risk – Elevated blood pressure – HDL cholesterol – IFG –LDL – LDL cholesterol – LDL particle size – NCEP ATP III definition – Smoking