Low density lipoprotein particles are small in patients with coronary vasospasm

Increased lipid oxidative stress has been recently implicated in the pathogenesis of coronary artery spasm. Small, dense LDL with high susceptibility to oxidation may be linked to the genesis of coronary vasospasm. The relative migratory distance of the predominant densitometric peak of LDL from that of VLDL to that of HDL in a 3% polyacrylamide gel electrophoresis was determined as a measure of LDL particle size in 49 patients with coronary spastic angina (CSA), in 56 patients with stable effort angina and a significant coronary artery stenosis (SEA) and also in 40 control subjects without coronary artery disease (Control). The incidence of detection of small, dense LDL (particle diameter <25.5 nm) or a relative migratory distance above 0.36 was significantly higher in CSA (57%) and also in SEA (39%) than in Control (20%). In SEA, a significantly higher serum level of triglyceride was noted in the subgroup with the small, dense LDL as compared with the subgroup without. In contrast, in CSA, the serum level of triglyceride was not significantly different between the subgroups with and without the small, dense LDL, although significantly lower serum levels of both HDL-cholesterol and alpha-tocopherol were noted in the former. In 16 patients of CSA, the detection of the small, dense LDL was significantly decreased after a >6-month angina-free period (69-->31%). We conclude that patients with coronary spastic angina had smaller LDL particles, associated not with hypertriglyceridemia but low serum levels of both HDL-cholesterol and vitamin E. Dyslipidemia with small, dense LDL may be related to the genesis of coronary vasospasm.