Abstract
BackgroundElevation in small dense low-density lipoprotein (sdLDL) is common in patients with diabetes mellitus (DM), which has already been reported to be associated with incidence of coronary artery disease (CAD). The aim of the present study was to investigate the prognostic value of plasma sdLDL level in patients with stable CAD and DM.MethodsA total of 4148 consecutive patients with stable CAD were prospectively enrolled into the study and followed up for major cardiovascular events (MACEs) up to 8.5 years. Plasma sdLDL level was measured in each patient by a direct method using automated chemistry analyzer. The patients were subsequently divided into four groups by the quartiles of sdLDL and the association of sdLDL level with MACEs in different status of glucose metabolism [DM, Pre-DM, normal glycaemia regulation (NGR)] was evaluated.ResultsA total of 464 MACEs were documented. Both Kaplan–Meier analysis and Cox regression analysis indicated that the patients in quartile 4 but not quartile 2 or 3 of sdLDL level had significantly higher rate of MACEs than that in lowest quartile. When the prognostic value of high sdLDL was assessed in different glucose metabolism status, the results showed that the high sdLDL plus DM was associated with worse outcome after adjustment of confounding risk factors (hazard ratio: 1.83, 95% confident interval: 1.24–2.70, p < 0.05). However, no significant association was observed for high sdLDL plus Pre-DM or NGR.ConclusionsThe present study firstly indicated that elevated levels of plasma sdLDL were associated with increased risk of MACEs among DM patients with proven CAD, suggesting that sdLDL may be useful for CAD risk stratification in DM.
Highlights
Elevation in small dense low-density lipoprotein is common in patients with diabetes mellitus (DM), which has already been reported to be associated with incidence of coronary artery disease (CAD)
The body mass index (BMI), glucose, haemoglobin A1c (HbA1c), total cholesterol (TC), LDLC, TG increased while the proportions of family history of CAD, and statin use decreased according to levels of small dense low-density lipoprotein (sdLDL) (p < 0.001)
Patients with sdLDL Q4 had the highest proportion of hypertension, highest Gensini score (GS) and the lowest proportion of normal glycaemia regulation (NGR) while those with sdLDL Q3 had the highest proportion of Pre-DM and lowest level of High density lipoprotein cholesterol (HDL-C)
Summary
Elevation in small dense low-density lipoprotein (sdLDL) is common in patients with diabetes mellitus (DM), which has already been reported to be associated with incidence of coronary artery disease (CAD). LDL particles are heterogeneous in size and density and can be categorized into large, buoyant LDL (lbLDL) and small, dense LDL (sdLDL) [4]. The particles of sdLDL have smaller size, higher penetration into the arterial wall, lower binding affinity for the LDL receptor, longer plasma residence time, and increased susceptibility to oxidation [7,8,9,10]. In two large observational cohort studies, sdLDL could predict the incident CAD among individuals with low cardiovascular risk according to their LDL-C levels [5, 13]. Among secondary prevention patients, the role of sdLDL in the progression of atherosclerotic cardiovascular disease (ASCVD) was less determined
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