High Prevalence of Small Dense LDL as an Underestimated Component of Heart Transplantation–Induced Dyslipidemia: Potential Role in Graft Coronary Vasculopathy?

Abstract

Heart transplantation–induced dyslipidemia is a recognized risk factor for cardiac allograft vasculopathy that affects survival prognosis. Beyond increased lipids, low-density lipoprotein (LDL) size and systemic factors, including glucose intolerance, oxidative stress, and inflammation, must be taken into account as components of the atherosclerotic risk. The aim of this study was to explore the atherogenic profile of heart transplant recipients (HTR) by assessing lipid parameters, glycemia, oxidative stress status, and inflammation in 59 transplant patients (follow-up of 6 ± 3 years) compared to 20 healthy volunteers. Classical hypercholesterolemia and hypertriglyceridemia were observed in HTR compared to controls, associated with increased apoCIII levels (0.13 ± 0.6 vs 0.07 ± 0.03 g/L, P < .01). Mean LDL size was reduced in HTR compared to controls (25.22 ± 0.72 vs 26.06 ± 0.54 nm, P < .001) with an abnormally high prevalence (69% vs 0%, P < .001) of small dense LDL (<25.5 nm). Hyperglycemia (7.3 ± 3 vs 5.4 ± 0.8 mmol/L, P < .05) and inflammation (high-sensitive CRP: 3.1 ± 3 vs 1.6 ± 0.9 mg/L, P < .001) were evidenced in HTR since no difference in oxidative stress parameters was observed. In conclusion, a high prevalence of small dense LDL is an important component of posttransplantation dyslipidemia.