Objective
While recent genomic studies have focused attention on triglyceride (TG) rich lipoproteins in cardiovascular disease (CVD), little is known of very low-density lipoprotein cholesterol (VLDL-C) relationship with atherosclerosis and CVD. We examined, in a high-risk type-2 diabetic population, the association of plasma VLDL-C with coronary artery calcification (CAC).
Methods
The Penn Diabetes Heart Study (PDHS) is a cross-sectional study of CVD risk factors in type-2 diabetics (n=2118, mean age 59.1 years, 36.5% female, 34.1% Black). Plasma lipids including VLDL-C were calculated (n=1879) after ultracentrifugation.
Results
In Tobit regression, VLDL-C levels were positively associated with increasing CAC after adjusting for age, race, gender, Framingham risk score, body mass index, C-reactive protein, exercise, medication and alcohol use, hemoglobin A1c, and diabetes duration [Tobit ratio (TR) and 95% confidence interval (CI) 0.38 (0.12–0.65), P=0.005] and even after inclusion of apolipoprotein B data [TR 0.31 (0.03–0.58), P=0.030]. Approximately 3-fold stronger effect was observed in women [TR 0.75 (0.16 – 1.34), P=0.013] than men [TR 0.20 (−0.10–0.50), P=0.189; gender interaction P=0.034]. Plasma VLDL-C was related more strongly to CAC scores than TG levels (e.g., Akaike information criteria of 7263.65 v. 7263.94) and had stronger CAC association in individuals with TGs >150mg/dl (TR 0.80, P=0.010) vs. those with TGs <150 mg/dl (TR 0.27, P=0.185).
Conclusions
In PDHS, VLDL-C is associated with CAC independent of established CVD risk factors, particularly in women, and may have value even beyond apolipoprotein B levels and in patients with elevated TGs.
