Abstract
BackgroundMisclassification of patients as low cardiovascular risk (LCR) remains a major concern and challenges the efficacy of traditional risk markers. Due to its strong association with cholesterol acceptor capacity, high-density lipoprotein (HDL) size has been appointed as a potential risk marker. Hence, we investigate whether HDL size improves the predictive value of HDL-cholesterol in the identification of carotid atherosclerotic burden in individuals stratified to be at LCR.Methods and Findings284 individuals (40–75 years) classified as LCR by the current US guidelines were selected in a three-step procedure from primary care centers of the cities of Campinas and Americana, SP, Brazil. Apolipoprotein B-containing lipoproteins were precipitated by polyethylene glycol and HDL size was measured by dynamic light scattering (DLS) technique. Participants were classified in tertiles of HDL size (<7.57; 7.57–8.22; >8.22 nm). Carotid intima-media thickness (cIMT) <0.90 mm (80th percentile) was determined by high resolution ultrasonography and multivariate ordinal regression models were used to assess the association between cIMT across HDL size and levels of lipid parameters. HDL-cholesterol was not associated with cIMT. In contrast, HDL size >8.22 nm was independently associated with low cIMT in either unadjusted and adjusted models for age, gender and Homeostasis Model Assessment 2 index for insulin sensitivity, ethnicity and body mass index (Odds ratio 0.23; 95% confidence interval 0.07–0.74, p = 0.013).ConclusionThe mean HDL size estimated with DLS constitutes a better predictor for subclinical carotid atherosclerosis than the conventional measurements of plasma HDL-cholesterol in individuals classified as LCR.
Highlights
It is of particular concern that, depending of the risk score applied, up to 72% of patients admitted with ST-elevation would have originally been classified to be at low cardiovascular (CV) risk just prior to the event [1]
The main finding of the study is that it is not high-density lipoprotein (HDL)-C levels but HDL particle size that improves the discrimination of individuals with or without increased Carotid intima-media thickness (cIMT) among those considered at low CV risk
This association remains significant after adjustment for low-density lipoprotein cholesterol (LDL-C), insulin sensitivity and the presence of traditional CV risk factors
Summary
It is of particular concern that, depending of the risk score applied, up to 72% of patients admitted with ST-elevation would have originally been classified to be at low cardiovascular (CV) risk just prior to the event [1]. Such limitation of risk algorithms draws attention to the possible inconsistencies between a few of their risk markers and their true CV risk. Due to its strong association with cholesterol acceptor capacity, high-density lipoprotein (HDL) size has been appointed as a potential risk marker. HDL size .8.22 nm was independently associated with low cIMT in either unadjusted and adjusted models for age, gender and Homeostasis Model Assessment 2 index for insulin sensitivity, PLOS ONE | DOI:10.1371/journal.pone.0114212 December 3, 2014
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