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Impaired antioxidant HDL function is associated with premature myocardial infarction
Klaus Distelmaier1, Franz Wiesbauer1, Hermann Blessberger2
1Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
Insights
Impaired antioxidant function of high-density lipoprotein (HDL) is linked to premature acute myocardial infarction (AMI). Maintaining HDL function may become a key therapeutic strategy for patients with early-onset coronary artery disease.
Area of Science:
- Cardiovascular Medicine
- Lipid Metabolism
- Biomarkers of Cardiovascular Risk
Background:
- Serum high-density lipoprotein (HDL) cholesterol levels have limited predictive value for cardiovascular risk in coronary artery disease (CAD).
- HDL function, particularly its antioxidant capacity, may be a more sensitive indicator of cardiovascular risk than simple serum levels.
- The role of impaired antioxidant HDL function in the development of premature acute myocardial infarction (AMI) requires further investigation.
Purpose of the Study:
- To assess whether impaired antioxidant HDL function is associated with the development of premature AMI.
- To compare the antioxidant function and particle size of HDL in young AMI patients and age- and gender-matched controls.
Main Methods:
- A multicentre case-control study involving 184 participants (92 young AMI patients and 92 controls).
- Measurement of HDL antioxidant function using the HDL inflammatory index (HII).
- Analysis of HDL particle size and its correlation with HDL function.
Main Results:
- Antioxidant HDL function was significantly impaired in AMI patients during both the acute and chronic stable phases compared to controls.
- Impaired HDL function in the stable phase was independently associated with premature MI.
- Correlations between HDL subfractions and HDL function were lost in AMI patients, particularly for large and intermediate HDL particles.
Conclusions:
- Impaired antioxidant HDL function is an independent risk factor for premature AMI.
- Therapeutic strategies targeting HDL function may be beneficial for patients with premature CAD.
Background:
There is growing evidence that the predictive value of HDL cholesterol levels for cardiovascular risk stratification is limited in patients with coronary artery disease (CAD). HDL function seems to be a more sensitive surrogate of cardiovascular risk estimation than simple serum levels. Therefore, we aimed to assess whether impaired antioxidant HDL function is involved in the development of premature acute myocardial infarction (AMI).
Methods:
In this multicentre case-control study, we compared the antioxidant function of HDL, measured by the HDL inflammatory index (HII), and HDL particle size in 184 patients comprising 92 patients with AMI at a very young age (≤40 years of age) and 92 age- and gender-matched controls.
Results:
Antioxidant capacities of HDL were significantly impaired in the acute phase of AMI (HII of 1·50 [IQR 1·10-1·74] vs. 0·56 [IQR 0·41-0·86] in controls, P < 0·001 as well as in the chronic stable phase 1 year after the event (HII of 0·85 [IQR 0·72-1·03] vs. 0·56 [IQR 0·41-0·86], P < 0·001) compared to controls. Moreover, HDL function in the stable phase remained significantly associated with premature MI in adjusted logistic regression analysis with an OR of 2·24 per SD increase of HII (95% CI 1·28-3·91; P = 0·005). Analyses of HDL size revealed a significant correlation between all HDL subfractions and HDL function in controls, whereas this correlation was lost for large and intermediate HDL in AMI patients.
Conclusion:
Impaired antioxidant function of HDL is independently associated with the development of premature AMI. The maintenance of HDL function might evolve into a significant therapeutic target, especially in patients with premature CAD.
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