Association of small dense low-density lipoprotein with cardiovascular outcome in patients with coronary artery disease and diabetes: a prospective, observational cohort study

Jin, Jing‐Lu; Zhang, Huiwen; Cao, Ye‐Xuan; Liu, Huihui; Hua, Qi; Li, Yanfang; Zhang, Yan; Wu, Na‐Qiong; Zhu, Cheng‐Gang; Xu, Rui‐Xia; Gao, Ying; Li, Xin; Cui, Chuan-Jue; Li, Geng; Sun, Jing; Dong, Qian; Guo, Yuan‐Lin; Li, Jianjun

doi:10.1186/s12933-020-01015-6

Cited by 54 publications

(49 citation statements)

References 36 publications

(44 reference statements)

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“…Koba S et al recruited 482 stable CHD patients and 389 patients without CHD and indicated sdLDL-C level was more efficacious in predicting coronary severity [ 33 ]. A cohort study from china suggested that increased sdLDL-C were associated with higher risk of CV events in patients with diabetes and stable CAD [ 14 ]. Therefore, the current study might provide valuable further information on the relationship of sdLDL-C and CV events in patients with ACS undergoing PCI.…”

Section: Discussionmentioning

confidence: 99%

“…sdLDL-C has been found to be associated with increased risk for the development of CHD among the healthy participants with high or low risk of CVD [ 12 , 13 ] and increased risk for cardiovascular (CV) events in patients with stable CVD [ 14 ]. However, to date, few studies have explored the role of sdLDL-C in patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI).…”

Section: Introductionmentioning

confidence: 99%

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Relationship between small dense low density lipoprotein and cardiovascular events in patients with acute coronary syndrome undergoing percutaneous coronary intervention

Zhang

Ling

2021

BMC Cardiovasc Disord

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Background Residual risk remained significant despite effective low density lipoprotein cholesterol (LDL-C) lowering treatment. Small dense low density lipoprotein cholesterol (sdLDL-C) as part of LDL-C has been found to be predictor of coronary heart disease (CHD) and cardiovascular (CV) events in patients with stable CHD independently of LDL-C. However, to date, few studies have explored the role of sdLDL-C in patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI). Accordingly, this study aimed to evaluate the association of sdLDL-C with CV events in patients with ACS undergoing PCI. Methods Patients hospitalized with ACS undergoing PCI were enrolled and followed up for 18 months. The risk of sdLDL-C for CV events was compared according to sdLDL-C quartiles. The primary outcome was major cardiovascular and cerebrovascular adverse events (MACCE), which was the composite of all cause of death, nonfatal myocardial infarction (MI), nonfatal stroke or unplanned repeat revascularization. A Cox proportional hazards regression model was performed to estimate the risk of CV events. Subgroup analysis according to diabetes status and LDL-C were performed separately for MACCE. Results A total of 6092 patients were included in the analysis (age: 60.2 ± 10.13 years, male: 75.3%, BMI: 25.9 ± 3.33 kg/m2, dyslipidemia: 74.1% and diabetes: 44.5%). During 18 months of follow-up, 320 (5.2%) incident CV events occurred. Compared to the lowest sdLDL-C quartile group, patients in the highest quartile had a greater risk of CV events after multivariable adjustment (HR 1.92; 95% CI 1.37–2.70). In addition, it was mainly due to the increase of unplanned repeat revascularization. In the subgroup analyses, significant association was observed regardless of level of LDL-C and diabetes status. Conclusions Patients with elevated sdLDL-C have a higher risk of CV events in Chinese patients with ACS undergoing PCI, providing additional value for better risk assessment.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Relationship between small dense low density lipoprotein and cardiovascular events in patients with acute coronary syndrome undergoing percutaneous coronary intervention

Zhang

Ling

2021

BMC Cardiovasc Disord

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“…There may be other important risk factors to be considered [9][10][11]. The occurrence and development of atherosclerosis (AS) is not only related to the total amount of cholesterol, but may also be closely related to its heterogeneity [12]. According to the size and density, LDL can be divided into different subtypes, including large and light LDL (large buoyant low-density lipoprotein, lbLDL), intermediate-density LDL (intermediate-density lipoprotein, IDL), and small and dense LDL (small dense low-density lipoprotein, sdLDL).…”

Section: Discussionmentioning

confidence: 99%

Correlation Between Small and Dense Low Density Lipoprotein Cholesterol and Cardiovascular Events in Beijing Community Population

Wang

Cao

et al. 2020

Preprint

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BackgroundThe relationship between small dense low-density lipoprotein cholesterol (sdLDL-C) and different cardiovascular events has been observed in several large community studies, and the results have been controversial. However, there is currently no cross-sectional or longitudinal follow-up study on sdLDL-C in the Chinese hypertension population.MethodsWe analyzed the association of plasma sdLDL-C levels with major adverse cardiovascular events in 1325 subjects from a longitudinal follow-up community-based population in Beijing, China.ResultsDuring the follow-up period, a total of 191 subjects had MACEs. Cox regression analysis showed that sdLDL-C is a major risk factor for MACEs independent of sex, age, BMI, hypertension, diabetes, smoking, SBP, DBP, FBG, eGFR in the general community population (1.013 (1.001 -1.025, P <0.05)), but the correlation disappeared after adjusting for TC and HDL-C in Model 3. Cox analysis showed that hypertension combined with high level of sdLDL-C was still the risk factor for MACEs ((2.079 (1.039-4.148)).ConclusionsOur findings in the Chinese cohort support that sdLDL-C is a risk factor for major adverse cardiovascular events in hypertension subjects.

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“…The proatherogenic effect may partly account for the association between AIP and mortality. Moreover, AIP is a surrogate for concentration of atherogenic small dense of LDL particles which may predict all-cause mortality and adverse cardiovascular events [38]. In addition, AIP is associated with the degree of insulin resistance [39].…”

Section: Aip As a Composite Of Tg And Hdl-c Re Ects The Interactionmentioning

confidence: 99%

Prognostic value of atherogenic index of plasma in patients with type 2 diabetes and acute coronary syndrome

Wang¹,

Cong²,

Zhang³

et al. 2020

Preprint

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Background: Atherogenic index of plasm (AIP) has been identified as a risk factor for cardiovascular disease (CVD) and an independent predictor of mortality. However, it remains unknown whether AIP level may predict mortality in patients with diabetes and acute coronary syndrome (ACS). Methods: A total of 2531 consecutive patients with type 2 diabetes who underwent coronary angiography for ACS were enrolled in the study. Patients were divided into tertiles according to admission AIP level. The AIP was calculated as the base 10 logarithm of the ratio of the fating concentration of triglyceride (TG) to high-density lipoprotein-cholesterol (HDL-C). The primary endpoints were all-cause death and cardiovascular death. Multivariate cox hazard regression analysis were performed to calculate the hazard ratio(HR)and 95％confidence interval(CI)．C-statistics, continuous net reclassification improvement(NRI)，and integrated discrimination improvement(IDI) were calculated to evaluate the added prognostic value of AIP beyond the established mode for prediction of death．Results: During 3-year follow-up, all-cause death events occurred in 142 cases and cardiovascular death events occurred in 120 cases, respectively. The risk of all-cause death and cardiovascular death increased with AIP tertiles at a 3-year follow-up. The Kaplan-Meier curves showed that significant differences in event-free survival rates among AIP tertiles(all-cause mortality: p=0.006; cardiovascular mortality: p=0.003).Multivariate cox hazard regression analysis revealed that AIP was independently associated with all-cause death (HR: 3.859, 95% CI:1.926-7.734; p<0.001) and cardiovascular death (HR:4.723, 95% CI: 2.243-9.946; p<0.001). Addition of AIP to the established mode for mortality prediction was not associated with a significant improvement in the C-statistics value but there were significant improvements in reclassification for all-cause death (NRI: 0.198, p=0.022; IDI: 0.008, p=0.016) and cardiovascular death (NRI: 0.260, p=0.006; IDI: 0.010, p=0.021).Conclusions: Admission AIP was independently correlated with long-term mortality in patients with type 2 diabetes and ACS. These findings suggest that AIP may optimize the mortality prediction among patients with diabetes and ACS.

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Association of small dense low-density lipoprotein with cardiovascular outcome in patients with coronary artery disease and diabetes: a prospective, observational cohort study

Cited by 54 publications

References 36 publications

Relationship between small dense low density lipoprotein and cardiovascular events in patients with acute coronary syndrome undergoing percutaneous coronary intervention

Relationship between small dense low density lipoprotein and cardiovascular events in patients with acute coronary syndrome undergoing percutaneous coronary intervention

Correlation Between Small and Dense Low Density Lipoprotein Cholesterol and Cardiovascular Events in Beijing Community Population

Prognostic value of atherogenic index of plasma in patients with type 2 diabetes and acute coronary syndrome

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