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Lipoprotein and apolipoprotein levels in angiographically defined coronary atherosclerosis
Insights
The ratio of high-density lipoprotein (HDL) cholesterol to total plasma cholesterol is a superior predictor of coronary artery disease (CAD) in men compared to other lipoprotein measures. Lower ratios indicate a higher likelihood of significant CAD.
Area of Science:
- Cardiovascular Medicine
- Lipid Metabolism
- Diagnostic Biomarkers
Background:
- Atherosclerotic coronary artery disease (CAD) poses a significant health risk.
- Traditional lipid profiles may not fully capture CAD risk.
- Novel biomarkers like apolipoproteins and HDL subfractions are being investigated.
Purpose of the Study:
- To evaluate the predictive value of various lipoprotein and apolipoprotein measures for CAD.
- To compare these novel predictors against traditional markers.
- To determine the most effective predictor for atherosclerotic coronary artery disease.
Main Methods:
- 126 patients with suspected CAD underwent coronary angiography.
- Measurements included plasma lipids, lipoproteins, and apolipoproteins.
- Multivariate logistic regression analysis was used to identify predictors.
Main Results:
- The ratio of high-density lipoprotein (HDL) cholesterol to total plasma cholesterol was the strongest independent predictor of CAD in men.
- Men with CAD had a significantly lower HDL cholesterol/total cholesterol ratio (0.17 +/- 0.01 mg/dl) than controls (0.23 +/- 0.02 mg/dl).
- A ratio below 0.15 mg/dl strongly indicated significant CAD in men.
Conclusions:
- The HDL cholesterol to total plasma cholesterol ratio may be a more effective predictor of CAD than many newer lipoprotein and apolipoprotein markers.
- This ratio offers a potentially superior method for assessing atherosclerotic coronary artery disease risk in men.
- Further research is needed to confirm these findings, especially in women due to limited sample size.
Abstract:
Recent studies suggest that apolipoproteins and subfractions of high-density lipoprotein (HDL) cholesterol may be better predictors of atherosclerotic coronary artery disease (CAD) than are plasma cholesterol and total HDL cholesterol. To examine this hypothesis, plasma cholesterol and triglyceride, cholesterol of low-density lipoprotein, HDL and its subfractions 2 and 3, apolipoprotein A-I, the apolipoprotein B of low-density lipoprotein, the ratio of apolipoprotein EII to EIII, and ratios of several of these variables were measured in a selected series of 126 patients (83 men and 43 women) who underwent coronary angiography for suspected CAD. Mean values of many of these variables differed significantly between the men with CAD and the men without significant CAD, when controlled for age, use of beta blockers and diuretic drugs. Using multivariate logistic regression analysis, the only variable that made a significant independent contribution in predicting CAD in men was the ratio of HDL cholesterol to total plasma cholesterol (p less than 0.0001). The mean of this ratio was 0.17 +/- 0.01 mg/dl in the men with CAD and 0.23 +/- 0.02 mg/dl in the male controls. All men with ratios of less than 0.15 mg/dl had significant CAD, defined as 50% or greater luminal diameter narrowing of 1 or more of the major coronary arteries. No measurement was a significant univariate or multivariate predictor of CAD in the women, but the power to detect such predictors was reduced because of small group sizes. In conclusion, the ratio of HDL cholesterol to plasma cholesterol may be superior to many of the more recently described lipoprotein and apolipoprotein-derived predictors of CAD.