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Metabolic determinants of the course of coronary artery disease in men
G F Watts1, S Mandalia, B M Slavin
1Department of Chemical Pathology, St. Thomas' Hospital, London, UK.
Insights
Low-density lipoprotein (LDL) cholesterol is the key metabolic predictor of coronary artery disease (CAD) progression in men. Measuring LDL cholesterol alone is sufficient for tracking CAD changes over time.
Area of Science:
- Cardiology
- Metabolic Syndrome
- Atherosclerosis Research
Background:
- Coronary artery disease (CAD) progression is influenced by various metabolic factors.
- Understanding these associations is crucial for effective disease management and treatment strategies.
Purpose of the Study:
- To investigate the relationship between metabolic variables and the progression of coronary artery disease (CAD).
- To identify the most significant metabolic predictor for changes in CAD over a three-year period.
Main Methods:
- Utilized data from the St. Thomas' Atherosclerosis Regression Study (STARS).
- Measured CAD progression using quantitative coronary angiography, assessing changes in mean absolute width of coronary segments (delta MAWS).
- Analyzed correlations between plasma concentrations of various metabolic variables and delta MAWS, employing multiple regression analysis.
Main Results:
- A decrease in MAWS (CAD progression) significantly correlated with plasma concentrations of cholesterol, low-density lipoprotein (LDL) cholesterol, apolipoprotein B (apoB), and lipoprotein(a) [Lp(a)].
- No significant associations were found with high-density lipoprotein (HDL) cholesterol, apoA-I, vitamin E, thyroid hormones, fibrinogen, von Willebrand factor, or glucose/insulin levels.
- Multiple regression analysis identified LDL cholesterol as the strongest predictor of delta MAWS, explaining 22% of the variance.
Conclusions:
- Plasma LDL cholesterol is the most important metabolic predictor of changes in symptomatic CAD in men.
- Measuring other variables like apoB or Lp(a) offers no additional advantage in predicting CAD changes when LDL cholesterol is known.
Abstract:
We examined associations between metabolic variables and changes in coronary artery disease (CAD) in the St. Thomas' Atherosclerosis Regression Study (STARS). The course of CAD over 3 years was measured continually by quantitative coronary angiography, i.e., as the per patient change in the mean absolute width of coronary segments (delta MAWS). The decrease in MAWS (progression of CAD) was significantly correlated with in-trial plasma concentrations of cholesterol (P = 0.002), low-density lipoprotein (LDL) cholesterol (P = 0.001), apolipoprotein B (apoB) (P = 0.008), and lipoprotein(a) [Lp(a)] (P = 0.004); no significant associations were found with high-density lipoprotein (HDL) cholesterol, apoA-I, vitamin E, thyroid hormones, fibrinogen, von Willebrand factor, or post-load plasma glucose and insulin concentrations. By multiple regression analysis, LDL cholesterol was the best predictor of delta MAWS, the adjusted model explaining 22% of the variance (P = 0.04). Thus, in men with symptomatic CAD the most important metabolic predictor of change in CAD is plasma LDL cholesterol, there being no advantage in measuring other variables, in particular, apoB or Lp(a).