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HDL Function and Size in Patients with On-Target LDL Plasma Levels and a First-Onset ACS

Alberto Cordero1,2,3, Natàlia Muñoz-García4, Teresa Padró3,4

  • 1Cardiology Department, Hospital Universitario de San Juan, 03550 Alicante, Spain.

International Journal of Molecular Sciences
|March 29, 2023
PubMed

Insights

This study reveals that for patients experiencing acute coronary syndrome (ACS) with normal lipid levels, impaired high-density lipoprotein (HDL) functionality and larger HDL particles are significant indicators. These findings highlight HDL functionality over concentration for assessing ACS risk.

Area of Science:

  • Cardiovascular Medicine
  • Lipidology
  • Biochemistry

Background:

  • Patients with acute coronary syndrome (ACS) often present with dyslipidemia, characterized by low high-density lipoprotein cholesterol (HDL-C) and high low-density lipoprotein cholesterol (LDL-C).
  • Assessing cardiovascular risk in ACS patients with seemingly controlled lipid levels requires investigation into lipoprotein functionality and particle characteristics.

Purpose of the Study:

  • To investigate the role of lipoprotein functionality, particle number, and size in first-onset ACS patients with on-target LDL-C levels.
  • To compare lipoprotein characteristics between ACS patients and non-ACS individuals with similar lipid profiles.

Main Methods:

  • Nuclear magnetic resonance (NMR) was used to assess HDL-C and LDL-C functionality, particle number, and size in 97 first-onset ACS patients and 31 healthy volunteers.
  • Patients were categorized as ACS or non-ACS based on diagnostic tests including ECG, echocardiogram, troponin levels, and angiography.
  • LDL susceptibility to oxidation and HDL antioxidant capacity were measured.

Main Results:

  • ACS patients exhibited higher LDL susceptibility to oxidation and lower HDL antioxidant capacity compared to non-ACS individuals.
  • Despite similar classical cardiovascular risk factors, ACS patients had lower HDL-C and Apolipoprotein A-I levels and impaired cholesterol efflux potential.
  • ACS-ST-segment-elevation myocardial infarction (STEMI) patients showed significantly larger HDL particle diameter than non-ACS individuals.

Conclusions:

  • Impaired lipoprotein functionality and larger HDL particles are observed in ACS patients even with on-target lipid levels.
  • HDL functionality, rather than just HDL-C concentration, is a crucial factor in assessing cardiovascular risk in ACS patients.
  • These findings suggest novel biomarkers for risk stratification in patients presenting with chest pain and first-onset ACS.

Keywords:
ACSHDL-CLDL-CNSTEMISTEMIcholesterol effluxlipoprotein functionality

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