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Association of atherogenic low-density lipoprotein subfractions with carotid atherosclerosis
M J Landray1, G Sagar, J Muskin
1University of Birmingham Department of Medicine at City Hospital, UK. m.j.landray@bham.ac.uk
Insights
Patients with carotid atherosclerosis have higher levels of small, dense low-density lipoprotein (LDL) particles, a key factor in plaque buildup. This finding suggests targeting LDL subfractions could help prevent stroke and heart disease.
Area of Science:
- Cardiovascular Medicine
- Atherosclerosis Research
- Lipid Metabolism
Background:
- Carotid atherosclerosis increases risk of stroke and ischemic heart disease.
- Low-density lipoprotein (LDL) is heterogeneous; small, dense LDL particles are more atherogenic.
- Understanding LDL subfractions' role in carotid atherosclerosis is crucial for risk stratification.
Purpose of the Study:
- To investigate the association between LDL subfractions and carotid atherosclerosis.
- To determine if LDL score predicts the presence of carotid atherosclerosis.
Main Methods:
- Studied 79 patients undergoing carotid Doppler ultrasound.
- Assessed carotid atherosclerosis by plaque, stenosis, or occlusion in six segments.
- Analyzed LDL subfractions using disc polyacrylamide gel electrophoresis to calculate an LDL score.
Main Results:
- Carotid atherosclerosis was present in 56% of patients.
- Mean LDL score was significantly higher in patients with carotid atherosclerosis (1.56) compared to those without (1.26).
- Age and smoking history were significant predictors; LDL score showed borderline significance.
Conclusions:
- Small, dense LDL subfractions are associated with carotid atherosclerosis.
- LDL score may serve as a modifiable risk factor for stroke and ischemic heart disease.
- Further research into LDL subfraction management is warranted for cardiovascular disease prevention.
Abstract:
Patients with carotid atherosclerosis are at increased risk of both stroke and ischaemic heart disease. Low-density lipoprotein (LDL) is a heterogeneous group of particles, with small, dense particles being more atherogenic. We studied 79 patients (51 men, mean +/- SD age 62.4 +/- 11.7 years) referred for Doppler ultrasound assessment of the carotid arteries. Evidence of carotid atherosclerosis, defined as the presence of atherosclerotic plaque, stenosis or occlusion in one or more of the six carotid artery segments examined, was found in 44 patients (56%). LDL subfractions were analysed by disc polyacrylamide gel electrophoresis with prior ultracentrifugation of serum to remove chylomicrons. This method produces a LDL score; the higher the score, the greater the proportion of the more atherogenic LDL subfractions. Mean LDL score was significantly higher in diseased patients (mean +/- SD, 1.56 +/- 0.61) than the normal group (1.26 +/- 0.65) (t = 2.12, p = 0.037). There was no significant association between LDL score and severity of carotid artery stenosis. Age (adjusted odds ratio 1.09, 95% CI 1.03-1.15) and smoking history (2.09, 95% CI 1.10-3.98) predicted carotid atherosclerosis in logistic regression analysis, with LDL score achieving borderline significance (2.20, 95% CI 0.91-5.29). Small, dense LDL subfractions are associated with carotid atherosclerosis and may be a modifiable risk factor for stroke as well as ischaemic heart disease.