Novel and traditional lipid-related biomarkers and their combinations in predicting coronary severity

Sha Li,Yuan-Lin Guo,Ying Gao,Xi Zhao,Xiao-Lin Li,Na-Qiong Wu,Cheng-Gang Zhu,Jing Sun,Rui-Xia Xu,Yan Zhang,Qian Dong,Jian-Jun Li,Geng Liu,Ping Qing

doi:10.1038/s41598-017-00499-9

Abstract

We investigated simultaneously traditional and novel lipid indices, alone or in combination, in predicting coronary severity assessed by Gensini score (GS) in 1605 non-lipid-lowering-drug-treated patients undergoing coronary angiography. Firstly, levels of triglycerides (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), non high density lipoprotein cholesterol (non-HDL-C), apolipoprotein (apo) B, lipoprotein (a) [Lp(a)], proprotein convertase subtilisin/kexin type 9 (PCSK9), apoC3, small dense LDL (sdLDL) and large HDL were increased, while HDL-C and apoA1 levels were decreased as GS status (all p for trend <0.05). However, gender stratification analyses showed similar associations between lipids and GS in men but not in women. Secondly, multiple logistic regression analyses indicated that the 12 indices were predictive for high GS (≥24) but not for low GS (1–23) compared with normal coronary (GS = 0) except for TG (neither) and apoB (both). Finally, we found that interactions between two indices with mutually exclusive composition were positively associated with GS status except for couples of TC + apoC3, apoB/PCSK9/apoC3 + sdLDL-C. Concordant elevations in the two showed the highest predictive values for high GS (all p for trend <0.05). Therefore, lipid biomarkers were associated with coronary severity and their adverse changes in combination emerged greater risks in men but not in women.

Highlights

Coronary artery disease (CAD) refers to atherosclerotic stenosis and/or myocardial ischemia, is increasing and life-threatening from young to old age[1, 2]
To date, emerging biomarkers based on lipids have been identified, such as proprotein convertase subtilisin/kexin type 9 (PCSK9)[16, 17], apolipoproteinC318, small dense LDL19 and large HDL20
55.5% were with hypertension, 19.4% were with diabetes mellitus, 77.5% were with dyslipidemia and 32.3% were current smokers

Summary

Introduction

Coronary artery disease (CAD) refers to atherosclerotic stenosis and/or myocardial ischemia, is increasing and life-threatening from young to old age[1, 2]. Circulating total cholesterol (TC) or low density lipoprotein (LDL) cholesterol (LDL-C) is associated with the development of CAD in an independent and graded manner and fulfill the criteria for causality[3, 6]. The causality underlying these associations remains to be further studied[5, 9, 10] and benefits of their level improvements are uncertain, their values in combination with LDL-C are gaining attention[11,12,13]. Traditional lipid measurements seem to have explained the major cardiovascular risk in diseased population, but it remains an unmet need for more diagnostic or therapeutic markers to evaluate CAD status and residual risk[14, 15]. Circulating lipid biomarkers, traditional or new emerging, alone or in combination, may be considered comprehensively in CAD risk evaluation. New emerging lipid indices for coronary severity in a large cohort of Chinese non-lipid-lowering-drug-treated patients undergoing coronary angiography (CAG)

Methods

Results

Conclusion