Very low-density lipoprotein cholesterol is associated with extent and severity of coronary artery disease in patients with type 2 diabetes mellitus

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Abstract

Objective:

Patients with type 2 diabetes mellitus usually have multiple cardiovascular disease risk factors. The objective of this study was to examine the severity and associated risk factors in coronary artery disease patients with type 2 diabetes mellitus.

Methods:

Two hundred and five coronary artery disease patients with type 2 diabetes mellitus and 205 age-, gender- and smoking-matched coronary artery disease patients without type 2 diabetes mellitus were recruited from the Department of Cardiology of our hospital. Demographic and clinical data were collected for all participants. Severity of coronary artery disease was assessed using Gensini scoring system, the number of diseased coronary arteries, and the extent of coronary stenosis.

Results:

Coronary artery disease patients with type 2 diabetes mellitus had higher Gensini scores (p < 0.01), more numbers of diseased coronary arteries (p < 0.001), and higher degrees of coronary stenosis (p = 0.05) than coronary artery disease patients without type 2 diabetes mellitus. The plasma levels of very low-density lipoprotein cholesterol (p < 0.001) and triglycerides (p < 0.001) were also higher in coronary artery disease patients with type 2 diabetes mellitus than in coronary artery disease patients without type 2 diabetes mellitus. In coronary artery disease patients with type 2 diabetes mellitus, very low-density lipoprotein cholesterol was positively correlated with Gensini scores (r = 0.15, p = 0.03), the number of diseased coronary arteries (r = 0.15, p = 0.04), and the extent of coronary stenosis (r = 0.14, p = 0.05) by partial correlation analysis after controlling for other lipid parameters, and independently associated with Gensini scores (beta = 0.18, p = 0.02) and the number of diseased coronary arteries (odds ratio = 2.09, p = 0.05) after adjusting for other cardiovascular risk factors in the following multiple regression analysis.

Conclusion:

Very low-density lipoprotein cholesterol may represent a marker for the severity of coronary artery disease and be a target for the treatment in diabetic patients. Further research is needed to determine whether very low-density lipoprotein cholesterol plays a causal role of coronary artery disease in diabetic patients.

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Most cited references 18

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Remnant-Like Particle Cholesterol, Low-Density Lipoprotein Triglycerides, and Incident Cardiovascular Disease

Vijay Nambi, Josef Coresh, Eric Boerwinkle … (2018)

Background Hypertriglyceridemia is associated with increased remnant-like particle cholesterol (RLP-C) and triglycerides in LDL (LDL-TG). Recent studies have focused on atherogenicity of RLP-C, with few data on LDL-TG. Objectives We examined associations of RLP-C and LDL-TG with incident cardiovascular disease (CVD) events and genetic variants in the Atherosclerosis Risk in Communities study. Methods Fasting plasma RLP-C and LDL-TG levels were measured in 9334 men and women without prevalent CVD. Participants were followed for incident CVD events (coronary heart disease [CHD] and ischemic stroke) for up to 16 years. Associations between LDL-TG and RLP-C levels and genetic variants were assessed by whole exome sequencing using single-variant analysis for common variants and gene-based burden tests for rare variants; both an unbiased and a candidate gene approach were explored Results RLP-C and LDL-TG levels were correlated with triglyceride levels (r=0.85 and r=0.64, p<0.0001). In minimally adjusted analyses, RLP-C and LDL-TG were associated with CVD risk, but in models adjusted for traditional risk factors including lipids, only LDL-TG was associated with incident CHD (hazard ratio [HR] 1.28, 95% confidence interval [CI] 1.10–1.50) and stroke (HR 1.47, 95% CI 1.13–1.92). A common APOE variant, rs7412, had the strongest association with LDL-TG and RLP-C (p<5×10 −8 ). Conclusions RLP-C and LDL-TG levels were predictive of CVD and associated with APOE variants. LDL-TG may represent a marker of dysfunctional remnant lipoprotein metabolism associated with increased CVD risk. Further research is needed to determine whether LDL-TG plays a causal role in CVD and may be a target for therapy.

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Remnant Lipoprotein Cholesterol and Incident Coronary Heart Disease: The Jackson Heart and Framingham Offspring Cohort Studies

Parag Joshi, Arif Khokhar, Joseph Massaro … (2016)

Background Remnant lipoproteins (RLPs), the triglyceride‐enriched precursors to low‐density lipoprotein, are an emerging risk factor for coronary heart disease (CHD). We sought to determine the association of RLP cholesterol (RLP‐C) levels with incident CHD in 2 diverse, prospective, longitudinal observational US cohorts. Methods and Results We analyzed cholesterol levels from serum lipoprotein samples separated via density gradient ultracentrifugation in 4114 US black participants (mean age 53.8 years, 64% women) from the Jackson Heart Study and a random sample of 818 predominantly white participants (mean age 57.3 years, 52% women) from the Framingham Offspring Cohort Study. Multivariable‐adjusted hazard ratios (HRs) for RLP‐C (the sum of very low‐density lipoprotein3 cholesterol and intermediate‐density lipoprotein cholesterol) were derived to estimate associations with incident CHD events consisting of myocardial infarction, CHD death, and revascularizations for each cohort separately and as a combined population. There were 146 CHD events in the combined population. After adjustments for age, sex, body mass index, smoking, blood pressure, diabetes, and lipid‐lowering therapy for the combined population, RLP‐C (HR 1.23 per 1‐SD increase, 95% CI 1.06–1.42, P<0.01) and intermediate‐density lipoprotein cholesterol (HR 1.26 per 1‐SD increase, 95% CI 1.08–1.47, P<0.01) predicted CHD during an 8‐year follow‐up. Associations were attenuated by high‐density lipoprotein cholesterol and ultimately lost significance with inclusion of real low‐density lipoprotein cholesterol, which excludes Lp(a) and IDL cholesterol fractions. Similar associations were seen in multivariable analyses within each cohort. Conclusion RLP‐C levels are predictive of incident CHD in this diverse group of primary prevention subjects. Interventions aimed at reducing RLP‐C to prevent CHD warrant further intensive investigation. Clinical Trial Registration URL: http://www.ClinicalTrials.gov. Unique identifier: NCT00415415.

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Remnant lipoprotein levels in fasting serum predict coronary events in patients with coronary artery disease.

Y Mizuno, Lawrence Sugiyama, K Takazoe … (1999)

Remnant lipoproteins are atherogenic, but assays of remnants have not been available in routine clinical laboratories because of the lack of practical and validated methods. A simple and reliable method for such an assay, using an immunochemical approach, has recently been developed. This study prospectively examined whether remnant lipoprotein levels in fasting serum, measured by our method, may have prognostic value in patients with coronary artery disease (CAD). Remnant lipoprotein levels in fasting serum were measured in 135 patients with CAD by an immunoaffinity mixed gel containing anti-apolipoprotein (apo) A-1 and anti-apoB-100 monoclonal antibodies. Patients were followed up for 5.1 mg cholesterol/dL; 75th percentile of distribution of remnant levels) than in those with the lowest tertile of remnant levels (

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Author and article information

Journal

Journal ID (nlm-ta): SAGE Open Med

Journal ID (iso-abbrev): SAGE Open Med

Journal ID (publisher-id): SMO

Journal ID (hwp): spsmo

Title: SAGE Open Medicine

Publisher: SAGE Publications (Sage UK: London, England )

ISSN (Electronic): 2050-3121

Publication date (Electronic): 23 August 2019

Publication date Collection: 2019

Volume: 7

Electronic Location Identifier: 2050312119871786

Affiliations

[1 ]School of Preclinical Medicine and Nanchong Key Laboratory of Metabolic Drugs and Biological Products, North Sichuan Medical College, Nanchong, People’s Republic of China

[2 ]Department of Cardiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, People’s Republic of China

[3 ]School of Pharmacy, North Sichuan Medical College, Nanchong, People’s Republic of China

Author notes

[*]Yongyan Song, School of Preclinical Medicine and Nanchong Key Laboratory of Metabolic Drugs and Biological Products, North Sichuan Medical College, Nanchong 637000, People’s Republic of China. Email: songyongyan2014@ 123456foxmail.com

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Yongyan Song https://orcid.org/0000-0001-6886-0873

Article

Publisher ID: 10.1177_2050312119871786

DOI: 10.1177/2050312119871786

PMC ID: 6710685

PubMed ID: 31489192

SO-VID: b8a8a5ad-dc7f-4827-849f-08f6bc1815bd

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This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

History

Date received : 17 April 2019

Date accepted : 1 August 2019

Funding

Funded by: education department of sichuan province, FundRef https://doi.org/10.13039/501100004884;

Award ID: [17ZA0172]

Funded by: the Cooperative Project on Scientific Research between Nanchong city and North Sichuan Medical College, People’s Republic of China, ;

Award ID: [NSMC20170403]

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cover-date January-December 2019

Keywords: coronary artery disease,type 2 diabetes mellitus,very low-density lipoprotein cholesterol,severity,gensini score

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Keywords: coronary artery disease, type 2 diabetes mellitus, very low-density lipoprotein cholesterol, severity, gensini score

Very low-density lipoprotein cholesterol is associated with extent and severity of coronary artery disease in patients with type 2 diabetes mellitus

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Karger: Cardiovascular System

Most cited references 18

Remnant-Like Particle Cholesterol, Low-Density Lipoprotein Triglycerides, and Incident Cardiovascular Disease

Remnant Lipoprotein Cholesterol and Incident Coronary Heart Disease: The Jackson Heart and Framingham Offspring Cohort Studies

Remnant lipoprotein levels in fasting serum predict coronary events in patients with coronary artery disease.

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