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Published on: November 10, 2017

Levels of cholesterol in small LDL particles predict atherosclerosis progression and incident CHD in the

Paul T Williams1, Xue-Qiao Zhao, Santica M Marcovina

  • 1Life Sciences Division, Lawrence Berkeley Laboratory, Berkeley, California, United States of America.

Plos One
|March 6, 2013
PubMed

Insights

Small, dense LDL cholesterol subclasses, specifically LDL-IIIb, are linked to worsening coronary artery stenosis and increased cardiovascular events in patients with low HDL cholesterol. These findings highlight the importance of LDL subclass analysis in cardiovascular risk assessment.

Area of Science:

  • Cardiovascular Medicine
  • Lipid Metabolism
  • Atherosclerosis Research

Background:

  • The HDL-Atherosclerosis Treatment Study (HATS) investigated interventions for coronary artery disease.
  • Understanding the role of specific low-density lipoprotein (LDL) subclasses in atherosclerosis progression is crucial.
  • Previous research suggests varying clinical impact among different LDL particle sizes.

Purpose of the Study:

  • To determine if angiographically documented changes in coronary artery stenosis and clinical cardiovascular events in HATS participants were associated with specific LDL subclasses.
  • To investigate the independent contribution of LDL subclasses to cardiovascular outcomes beyond standard lipid measures.

Main Methods:

  • LDL subclass cholesterol concentrations were measured using gradient gel electrophoresis in participants receiving placebo, simvastatin-niacin, antioxidants, or combination therapy.
  • The primary endpoint was the change in percent stenosis of the most severe proximal coronary lesions from baseline to follow-up arteriography.
  • Clinical endpoints included coronary-related deaths, myocardial infarctions, stroke, and revascularization procedures.

Main Results:

  • Increased concentrations of small LDL subclasses, specifically LDL-IIIb and LDL-IVa, were associated with greater progression of coronary artery stenosis, particularly in lesions with less than 30% baseline stenosis.
  • Higher on-study LDL-IIIb cholesterol levels significantly increased the odds of primary clinical endpoints (cardiovascular death, MI, stroke, revascularization), even after adjusting for treatment, age, sex, BMI, and standard lipid values.
  • These associations remained significant both before and after adjustments for treatment group and standard lipid profiles.

Conclusions:

  • Plasma LDL-IIIb cholesterol concentration is a significant predictor of changes in coronary artery stenosis.
  • Elevated LDL-IIIb levels are associated with an increased risk of cardiovascular events in patients with coronary artery disease and low HDL-cholesterol.
  • These findings underscore the clinical relevance of assessing specific LDL subclasses for cardiovascular risk stratification.
Abstract

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