High-density lipoprotein subfractions in normolipidemic patients with coronary atherosclerosis.

Abstract

SUMMARY High-density lipoprotein (HDL) levels were studied in 10 male patients with severe coronary atherosclerosis and in 10 well-matched controls. All subjects were normolipidemic, and the presence of a disease or other factor influencing HDL levels was excluded. Very low density lipoprotein and low-density lipoprotein levels were similar in both groups, but HDL concentration was significantly lower in the patient group. Analysis of HDL subfractions revealed that both HDL2 and HDL3 concentrations were significantly lower in the patient group. The composition of both HDL subfractions was also altered in the patient group: an increased cholesterol-to-protein ratio was found. These data strengthen the evidence in support of an important and independent role for HDL in the pathogenesis of coronary atherosclerosis. It appears that both HDL2 and HDL3 are implicated and that both the concentration and composition of HDL are important.CORONARY heart disease (CHD) is the main cause of death in the Western world.' The pathogenesis of CHD is not clear, and the interrelationships of many factors appear to have a role. Hyperlipidemia increases the risk for CHD, but about half of the patients with CHD have normal plasma lipid levels. An inverse relationship between CHD and high-density lipoprotein (HDL) levels has been established for both the cholesterol and apoprotein components of the lipoprotein.2 3 HDL, however, is not a homogeneous moiety, and the concentration and composition of the HDL subclasses in CHD have hardly been studied. Gofman et al.4 determined the HDL2 and HDL3 concentrations of the lipoproteins by analytic ultracentrifugation. Concentrations of both subfractions were depressed in CHD patients, but because most of the patients were hyperlipidemic, interpretation of the results proved difficult.A positive cholesterol balance in the cells of the primary atherosclerotic lesion may be responsible for the evolution of this lesion into an advanced plaque,5 and HDL may remove cholesterol from extrahepatic tissues6 and thus prevent its accumulation. We therefore decided to study HDL concentration and composition in normolipidemic CHD patients. Patients with definite angiographic evidence of the disease were selected. Both the lipid and protein components of HDL and its subfractions were determined. Methods PatientsTen men, ages 38-64 years (mean 55 years), who had undergone coronary angiography for symptomatic CHD and were shown to have an occlusion of more than 70% of the diameter of at least one major coronary artery and who also fufilled the following criteria were selected for study. None gave a history of hyperlipide-

Effect of Alcohol on Lipids and Lipoproteins in Relation to Atherosclerosis

“…The protective effect of HDL has been related to high plasma concentrations of HDL 2 , 71,72 but also to both HDL 2 and HDL 3 in some studies. [73][74][75] In accordance with HDL 2 , LpA-I has been proposed as the more antiatherogenic subpopulation within HDL. [76][77][78][79][80] Alcohol intake increases plasma HDL cholesterol concentration.…”

Fish Oil Modifies Lipids and Reduces Platelet Aggregability in Haemodialysis Patients

“…How ever, HDLj as the initial acceptor may acquire choles terol and become converted to HDLj [17], Therefore, the HDL2/H D L3 profile could reflect the balance between uptake and clearance of cholesterol from cells [18]. Our patients had a mean HDL> cholesterol fraction similar to levels of non-uraemic patients with severe atherosclero sis, which were significantly lower than in a control population without atheroma [19].…”

Comparison of Several Atherogenicity Indices by the Analysis of Serum Lipoprotein Composition in Patients with Chronic Renal Failure with or without Haemodialysis, and in Renal Transplant Patients

“…The so-called cardiovascular risk factors were determined using either the ratio of cholesterol contained in HOL to that in (LDL + VLDL) or the ratio of apolipoprotein A to apolipoprotein B. Several studies indicated that the two modes of evaluation were not strictly superimposable, at least in the patient population with a history of myocardial infarct (12,(41)(42)(43). In the present uraemic patients äs well äs renal transplant patients, these ratios using cholesterol or phospholipids were decreased.…”