Small Dense Low-Density Lipoprotein Cholesterol: A Residual Risk for Rapid Progression of Non-Culprit Coronary Lesion in Patients with Acute Coronary Syndrome

Abstract

This study investigated whether the small dense low-density lipoprotein cholesterol (sd-LDL-c) level is associated with the rapid progression (RP) of non-culprit coronary artery lesions and cardiovascular events (CE) after acute coronary syndrome (ACS).Methods: In 142 consecutive patients with ACS who underwent primary percutaneous coronary intervention for the culprit lesion, the sd-LDL-c level was measured using a direct homogeneous assay on admission for ACS and at the 10-month follow-up coronary angiography. RP was defined as a progression of any pre-existing coronary stenosis and/or stenosis development in the initially normal coronary artery. CEs were defined as cardiac death, myocardial infarction, stroke, or coronary revascularization.Results: Patients were divided into two groups based on the presence (n 29) or absence (n 113) of RP after 10 months. The LDL-c and sd-LDL-c levels at baseline were equivalent in both the groups. However, the sd-LDL-c, triglyceride, remnant lipoprotein cholesterol (RL-c), and apoC3 levels at follow-up were significantly higher in the RP group than in the non-RP group. The optimal threshold values of sd-LDL-c, triglyceride, RL-c, and apoC3 for predicting RP according to receiver operating characteristics analysis were 20.9, 113, 5.5, and 9.7 mg/dL, respectively. Only the sd-LDL-c level (≥ 20.9 mg/dL) was significantly associated with incident CEs at 31 17 months (log-rank: 4.123, p 0.043). Conclusions:The sd-LDL-c level on treatment was significantly associated with RP of non-culprit lesions, resulting in CEs in ACS patients. On-treatment sd-LDL-c is a residual risk and aggressive reduction of sd-LDL-c might be needed to prevent CEs. medications, are recommended for reducing the subsequent risk of major cardiovascular events (CEs) in patients with ACS 1) . The suggested target LDL-c level is less than 70 mg/dL for the secondary prevention in ACS 2) . However, some patients present with CEs even after achieving an LDL-c level belowCopyright©2021 Japan Atherosclerosis Society This article is distributed under the terms of the latest version of CC BY-NC-SA defined by the Creative Commons Attribution License.

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

“…A positive correlation remained even among those with LDL-cholesterol < 100 mg/dL ( R = 0.67; Figure 2 B). If we used a cutoff of small dense LDL-cholesterol 20.9 mg/dL [ 11 ], a corresponding cutoff of triglyceride was calculated as 62.9 mg/dL. A moderately positive correlation was observed between small dense LDL-cholesterol and other lipid parameters, except for HDL-cholesterol ( Figure 3 A–C).…”

“…In our study, although conducted among a small sample-sized cohort, triglyceride level had a positive correlation with small dense LDL-cholesterol among those with acute coronary syndrome. Given that small-dense LDL-cholesterol is a risk factor for the development and progression of atherosclerosis [ 11 ] and that this important parameter cannot be routinely measured given challenges with insurance reimbursement in Japan, we might be able to utilize triglyceride as a promising marker in secondary risk prevention.…”

“…Several studies found that small dense LDL-cholesterol was elevated in patients with acute coronary syndrome [ 12 , 13 ]. 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, a relatively low triglyceride level (i.e., between 100 and 150 mg/dL) might not represent true lower freedom from cardiovascular events given a potential unmeasured interaction with small dense LDL-cholesterol. Consistently, we calculated a cutoff of triglyceride 62.9 mg/dL, which was statistically equivalent to 20.9 mg/dL of small dense LDL-cholesterol—a proposed cutoff to risk-stratify those with acute coronary syndrome [ 11 ]. Furthermore, closer attention must be given to obese patients given the additional risk of elevated small dense LDL-cholesterol independent of triglyceride levels.…”

Correlation of Triglyceride with Coronary Artery Disease Severity in Pre-Diabetic Chronic Stable Angina Patients

“…In the study of Sekimoto et al [22], patients were divided into two groups based on the presence (n=29) or absence (n=113) of RP after 10 months. The LDL-c and sd-LDL-c (small dense low-density lipoprotein cholesterol) levels at baseline were equivalent in both the groups.…”