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

Abstract

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.

High residual cardiovascular risk after lipid-lowering: prime time for Predictive, Preventive, Personalized, Participatory, and Psycho-cognitive medicine

“…One year later, the same group reported that sdLDL, HDL-TG and large concentrations of LDL particles were the most powerful predictors of CVD risk ( 8 ). Likewise, in patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI) those with elevated levels of sdLDL have higher risk of CV events compared to those without elevated sdLDL levels ( 9 ).…”

Prognostic Implication of Small Dense LDL-Cholesterol Levels following Acute Coronary Syndrome

“…Few studies investigated the prognostic impact of small dense LDL cholesterol among those with acute coronary syndrome, as examined in this study. In a study conducted by Zhang and colleagues, patients with elevated small dense LDL-cholesterol levels on admission had a higher risk of cardiovascular events in those with acute coronary syndrome receiving percutaneous coronary intervention [ 14 ]. We did not assess small dense LDL-cholesterol levels on admission as the trend in their levels should be determined after initiation of lipid-lowering agents that can also affect small dense LDL-cholesterol levels [ 16 ], most of which are initiated during index hospitalization.…”

“…The data on incident risk of small dense LDL cholesterol has primarily been reported among cohorts of patients with stable coronary artery disease [ 5 , 7 , 8 , 9 , 10 , 11 , 12 ], whereas the prognostic impact of small dense LDL-cholesterol levels among those with acute coronary syndrome remains uncertain [ 13 , 14 ]. More data on strategies to enhance secondary prevention of cardiovascular events among those with acute coronary syndrome are needed to prevent downstream events and further improve clinical outcomes following acute coronary syndrome.…”

Triglyceride and Small Dense LDL-Cholesterol in Patients with Acute Coronary Syndrome

“…Recently, Sekimoto and colleagues demonstrated that a small dense LDL-cholesterol > 20.9 mg/dL was associated with higher incidence of adverse events following acute coronary syndrome [ 11 ]. Another recent study also demonstrated that the elevated small dense LDL-cholesterol was a risk factor of future cardiovascular events following acute coronary syndrome [ 14 ]. Given our findings ( Figure 2 A), a cutoff of triglyceride 200 mg/dL, which is a cutoff currently recommended by the guidelines [ 10 ], might not be sufficient as a marker for accurate risk prediction in secondary prevention.…”