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Small Dense LDL Level and LDL/HDL Distribution in Acute Coronary Syndrome Patients
Alyann Otrante1, Abdelghani Bounafaa1,2, Hicham Berrougui1,3
1Geriatrics Unit, Department of Medicine, Faculty of Medicine and Biological Sciences, University of Sherbrooke, Sherbrooke, QC J1K 2R1, Canada.
Insights
Small dense low-density lipoprotein (sdLDL) levels are significantly elevated in North African acute coronary syndrome (ACS) patients. These sdLDL levels show high accuracy in predicting cardiovascular events.
Area of Science:
- Cardiology
- Lipidology
- Biochemistry
Background:
- Cardiovascular disease (CVD) risk is influenced by lipoprotein particle size and distribution.
- Small dense low-density lipoprotein (sdLDL) particles are considered more atherogenic than larger LDL particles.
Purpose of the Study:
- To determine LDL and HDL particle size and distribution in North African ACS patients.
- To compare sdLDL levels with established cardiovascular risk markers.
Main Methods:
- Quantimetric Lipoprint analysis of LDL and HDL subclasses in 205 ACS patients and 100 controls.
- Calculation of lipid ratios, atherogenic index (AIP), atherogenic coefficient (AC), and Castelli's Risk (CR-I, CR-II).
- Receiver operating characteristic (ROC) curve analysis to evaluate sdLDL predictive value.
Main Results:
- ACS patients exhibited significantly higher sdLDL concentrations compared to healthy controls (p < 0.001).
- sdLDL levels demonstrated high discrimination accuracy for ACS (AUC = 0.847).
- Altered HDL subclass distribution was observed in ACS patients, with increased small HDL particles.
Conclusions:
- Elevated sdLDL levels are a significant finding in North African ACS patients.
- sdLDL is a valuable and highly accurate marker for predicting cardiovascular events due to its atherogenicity.
Abstract:
This study aimed to determine the size and distribution of LDL and HDL particles in North African acute coronary syndrome (ACS) patients and to compare the level of small dense LDL (sdLDL) to other markers used in cardiovascular risk prediction.
Methods:
A total of 205 ACS patients and 100 healthy control subjects were enrolled. LDL particle size and LDL and HDL subclass distributions were measured using Quantimetric Lipoprint® linear polyacrylamide gel electrophoresis. Lipid ratios (total cholesterol, LDL cholesterol, non-HDL cholesterol, and HDL cholesterol) were determined to calculate the atherogenic index of plasma (AIP), the atherogenic coefficient (AC), Castelli's Risk-I (CR-I), and Castelli's Risk-II (CR-II). Receiver operating characteristic (ROC) curve analyses and area under the curve (AUC) were used to assess the predictive value of sdLDL as a marker for cardiovascular disease.
Results:
The ACS patients, compared to the healthy control subjects, displayed an alteration of LDL particle distribution, with a significant increase in sdLDL serum concentrations (0.303 ± 0.478 mmol/L vs. 0.0225 ± 0.043 mmol/L, respectively, p < 0.001). The sdLDL levels had a high discrimination accuracy [AUC = 0.847 ± 0.0353 (95% CI 0.778 to 0.916, p < 0.0001)]. The best predictive cutoff value of ACS determined with the maximum Youden index (J) [(sensitivity + specificity) - 1 = 0.60] was 0.038 mmol/L. A Spearman correlation analysis showed that sdLDL levels were moderately but significantly and positively correlated with AC and CR-I (r = 0.37, p < 0.001) and weakly but significantly correlated with PAI and CR-II; r = 0.32 (p < 0.001) and r = 0.30 (p < 0.008), respectively. The subclass distribution of HDL particles from ACS patients was also altered, with a decrease in large HDL particles and an increase in small HDL particles compared to HDL from healthy control subjects.
Conclusion:
Due to their high atherogenicity, sdLDL levels could be used as a valuable marker for the prediction cardiovascular events.
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