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HDL-cholesterol concentration and severity of coronary atherosclerosis determined by cine-angiography
Insights
The ratio of HDL-phospholipid to total cholesterol (HDL-P/TC) is a better predictor of coronary artery disease (CAD) severity than HDL-cholesterol alone. A low HDL-P/TC ratio may indicate increased CAD risk.
Area of Science:
- Cardiovascular Medicine
- Lipidology
- Biochemistry
Background:
- Coronary artery disease (CAD) is a leading cause of mortality worldwide.
- Serum lipid and lipoprotein levels are established risk factors for CAD.
- The predictive value of specific lipid ratios for CAD severity requires further investigation.
Purpose of the Study:
- To investigate the correlation between various serum lipid and lipoprotein levels and the severity of coronary artery disease (CAD) in adult males.
- To identify the most effective lipid predictor for CAD stage.
Main Methods:
- Serum lipid and lipoprotein levels (including total cholesterol, triglycerides, HDL-cholesterol, LDL-cholesterol, HDL-phospholipid, and various ratios) were measured in 226 adult male subjects.
- Coronary arteriography was performed to assess the severity of CAD.
- Statistical analyses, including linear regression and one-way ANOVA, were used to correlate lipid variables with CAD severity.
Main Results:
- The ratio of HDL-phospholipid to total cholesterol (HDL-P/TC) showed the strongest statistically significant inverse correlation with CAD severity (r=-0.24, P < 0.001).
- Other significant predictors included HDL-C/TC, LDL-C/HDL-P, and HDL-P.
- HDL-P/TC was identified as the best predictor of CAD stage by one-way ANOVA, even after adjusting for covariates.
Conclusions:
- The HDL-P/TC ratio is a more effective predictor of CAD severity than HDL-cholesterol alone.
- A low HDL-P/TC ratio may serve as a risk factor for CAD.
- While statistically significant, HDL-P/TC is not a dependable clinical diagnostic aid for individual CAD severity prediction.
Abstract:
We studied 226 adult male subjects (mean=52yr) who underwent coronary arteriography. Their serum lipid and lipoprotein levels [total cholesterol (TC), triglycerides (TG), HDL-cholesterol (HDL-C), LDL-C, HDL-phospholipid (HDL-P), HDL-TG, HDL-C/TC, HDL-P/TC, LDL-C/TC, LDL-C/HDL-C and LDL-C/HDL-P] were correlated with the severity of coronary artery disease (CAD). Studies showed a slight but statistically significant correlation (linear regression) between CAD and HDL-P/TC (r=-0.24, P < 0.001), HDL-C/TC (r=-0.20, P < 0.002), followed by LDL-C/HDL-P (r=0.19, P < 0.004) and HDL-P (r=-0.18, P < 0.008). HDL-C, LDL-C and TC were significant at the P < 0.05 level; P value of TG was non-significant. Subjects were conveniently grouped based on degree of coronary artery narrowing: normal, mild (1-50%); moderate-severe (51-99%) and very severe (100% occlusion). Of the 11 lipid variables, the best predictor of the stage of the CAD was HDL-P/TC as measured by one-way analysis of variance. This trend was unaltered even after adjustment for covariates. HDL-P, LDL-C/HDL-P and HDL-C/TC were also significant, but the other lipid parameters were not. The study indicates that HDL-C, by itself, is not as effective a predictor of CAD as HDL-P/TC. Also, the small but statistically significant inverse relationship between HDL-P/TC and CAD suggests that a low HDL-P/TC ratio can be considered a risk factor for CAD but not as a dependable clinical diagnostic aid for predicting the severity of CAD on an individual basis.