Abstract
HDL-Cholesterol (HDL-C) is not an accurate surrogate marker to measure the cardioprotective functions of HDL in coronary artery diseases (CAD) patients. Hence, measurement of other HDL-related parameters may have prognostic superiority over HDL-C. In this work, we examined the predictive value of HDL particles profile for long-term mortality in CAD patients and to compare its informative value to that of HDL-C and apoA-I. HDL particles profiles were measured by nuclear magnetic resonance (NMR) spectroscopy in 214 male participants with stable CAD (45–74 years). Median follow up was 12.5 years with a 36.4% mortality rate. Cardiovascular mortality accounted for 64.5%. Mean concentrations of total HDL particles (HDL-P), small-sized HDL (SHDL-P) and apoA-I were lower in deceased than in surviving patients whereas no difference was observed according to HDL-C and large HDL particles. All NMR-HDL measures were correlated between themselves and with other HDL markers (HDL-C, apoA-I and LpA-I). In a multivariate model adjusted for cardiovascular risk factors and bioclinical variables, HDL-P and SHDL-P displayed the strongest inverse association with all-cause and cardiovascular mortality. Weaker associations were recorded for apoA-I. Based on our results, we conclude that HDL particle profile measured by NMR spectroscopy should be considered to better stratify risk in population at high risk or in the setting of pharmacotherapy.
Highlights
HDL-Cholesterol (HDL-C) has been repeatedly inversely related to cardiovascular risk in all epidemiological studies
Some genetic variants associated to increased HDL-C have not been found associated to a decreased cardiovascular risk[2] but those HDL randomization studies are questionable because they disregarded the complexity of lipoprotein metabolism by excluding from their analyses important genes that not exclusively regulate HDL-C levels and those of other lipoproteins[3,4]
Numerous recent studies have shown that the atheroprotective properties of HDL are supported by small and medium-sized HDL particles[6], which were inversely related to cardiovascular risk in various clinical settings[7,8]
Summary
HDL-Cholesterol (HDL-C) has been repeatedly inversely related to cardiovascular risk in all epidemiological studies. Current smoking Past smoking Never smoking Alcohol, g/day Physical activity, high levela, % Hypertensionb, % Treatment Hypertension, % Dyslipidemiab, % Treatment dyslipidemia, % Treatment with statins, % Treatment with fibrates, % Diabetesb, % Treatment diabetes, % Waist circumference, cm BMI, kg/m2 Systolic blood pressure, mm Hg Heart rate, beats/min Triglycerides, g/L Total cholesterol, g/L LDL-C, g/L HDL-C, g/L ApoA-I, g/L Lipoprotein A-I, g/L eGFR
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