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Plasma remnant-like lipoprotein particles or LDL-C as major pathologic factors in sudden cardiac death cases
Katsuyuki Nakajima1, Yasuhiro Nakajima, Sanae Takeichi
1Department of Forensic Medicine, Tokai University School of Medicine, Isehara, Kanagawa 259-1193, Japan. nakajimak05@ybb.ne.jp
Insights
Sudden cardiac death (SCD) and Pokkuri death syndrome (PDS) are linked to high remnant-like lipoprotein particles (RLP), not LDL-cholesterol. RLP levels are a key factor in cardiovascular events, especially in PDS cases with normal arteries.
Area of Science:
- Cardiovascular Research
- Lipid Metabolism
- Sudden Cardiac Death Etiology
Background:
- Sudden cardiac death (SCD) in Japanese subjects is often linked to postprandial hyperlipidemia.
- Pokkuri death syndrome (PDS) presents with near-normal coronary arteries, posing a diagnostic challenge for cardiovascular risk assessment.
Purpose of the Study:
- To compare the predictive value of LDL-cholesterol (LDL-C) and remnant-like lipoprotein particles (RLP) as cardiovascular risk factors in SCD and PDS cases.
- To determine cut-off values and likelihood ratios for RLP-cholesterol (RLP-C), RLP-triglyceride (RLP-TG), and LDL-C in fatal events.
Main Methods:
- Receiver Operating Characteristic (ROC) analysis was used to calculate cut-off values and likelihood ratios for RLP-C, RLP-TG, and LDL-C.
- Plasma lipid levels were compared between sudden cardiac death (SCD) cases, PDS cases, and control death cases.
Main Results:
- Higher incidence of elevated RLP-C, RLP-TG, and LDL-C was observed in SCD cases compared to controls.
- PDS cases showed significantly higher RLP-C and RLP-TG levels compared to controls, but not significantly elevated LDL-C.
- RLP-C and RLP-TG demonstrated higher likelihood ratios than LDL-C in predicting fatal cardiovascular events, particularly in PDS.
Conclusions:
- Elevated plasma remnant lipoproteins (RLP-C, RLP-TG) are significant risk factors for sudden cardiac death and Pokkuri death syndrome.
- RLP levels, rather than LDL-C, appear to be a major pathological factor in cardiovascular events, especially in PDS.
- PDS cases are characterized by high remnant lipoprotein levels without significant atherosclerotic lesions or elevated LDL-C.
Abstract:
We have previously reported that the majority of sudden cardiac death (SCD) events were associated with postprandial hyperlipidemia in Japanese subjects. In this investigation, we have compared LDL-cholesterol (LDL-C) and remnant-like lipoprotein particles (RLP) as cardiovascular risk factors in SCD cases, especially in Pokkuri death syndrome (PDS) cases who had nearly normal coronary arteries. To predict the risk of plasma RLP-cholesterol, triglyceride (RLP-C, RLP-TG) and LDL-C in fatal clinical events associated with SCD cases with or without atherosclerosis (PDS), we calculated the cut-off values and likelihood ratio of these lipoproteins from ROC analysis. Sixty-eight percent of SCD cases were above cut-off value of RLP-C (>12.8 mg/dL) versus 32% for control death cases (P<0.0001) and the likelihood ratio of RLP-C was 2.12. Significantly higher incidence of RLP-C above cut-off value (>10.1 mg/dL) was seen in PDS compared to controls (P<0.0001) and the likelihood ratio was 3.13. Similarly, significantly higher incidence of RLP-TG above cut-off values, SCD>53 mg/dL and PDS>67 mg/dL, was seen compared to controls (P<0.0001) and the likelihood ratio was 1.86 and 2.73, respectively. Further, significantly higher incidence of LDL-C above cut-off value (>93 mg/dL) was seen in SCD compared to controls (P<0.0001) and the likelihood ratio was 1.68. However, the incidence of LDL-C above cut-off value (LDL-C>106 mg/dL) was not significantly different between PDS and controls and the likelihood ratio was 1.52. In conclusion, this study has shown high levels of plasma remnant lipoproteins in PDS and that PDS cases did not present with atherosclerotic lesions or elevated LDL-C. In contrast, SCD cases showed high levels of plasma remnant lipoproteins together with elevated plasma LDL-C. Accordingly, we believe that plasma remnant lipoproteins level rather than plasma LDL-C is a major pathologic factor in cardiovascular events.
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