Small dense low‐density lipoprotein cholesterol is a promising biomarker for secondary prevention in older men with stable coronary artery disease

Sakai, Koshiro; Koba, Shinji; Nakamura, Yuya; Yokota, Yuya; Tsunoda, Fumiyoshi; Miyake, Shoji; Itoh, Yasuki; Hamazaki, Yoko; Kobayashi, Youichi

doi:10.1111/ggi.13287

Cited by 35 publications

(35 citation statements)

References 26 publications

(51 reference statements)

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“…These considerations underline the importance of evaluating the profiles of functional status and frailty in geriatric patients, but certainly do not undermine the role of plasma cholesterol as a cardiovascular risk factor, even in the older population, as clearly pointed out in large meta‐analysis studies . Small dense LDL was recently identified as a biomarker for secondary prevention in older adults …”

Section: Cholesterol and Cardiovascular Risk In Older Patientsmentioning

confidence: 97%

“…27 Small dense LDL was recently identified as a biomarker for secondary prevention in older adults. 36 A limitation of the most common risk charts and functions is represented by the narrow age range, which in most cases does not exceed the sixth decade of life because of the original dataset from which the functions have been derived. This hardly allows for the extrapolation of risk estimate in older adults.…”

Section: Cholesterol and Cardiovascular Risk In Older Patientsmentioning

confidence: 99%

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Management of high cholesterol levels in older people

Bertolotti

Lancellotti

Mussi

2019

Geriatrics Gerontology Int

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The management of hypercholesterolemia in older adults still represents a challenge in clinical medicine. The pathophysiological alterations of cholesterol metabolism associated with aging are still incompletely understood, even if epidemiological evidence suggests that serum cholesterol levels increase with ongoing age, possibly with a plateau after the age of 80 years. Age is also one of the main determinants of cardiovascular disease, according to all cardiovascular risk estimate tools. Cholesterol‐lowering treatment, therefore, would be expected to bring significant protection, even in these patients. Unfortunately, direct experimental evidence is extremely limited, particularly in the very old age strata of the population; a clinical benefit still seems to be present, but the risk for drug‐related adverse events is clearly higher. At any rate, at the present time, definite guidelines for the correct management of hypercholesterolemia in older patients are not available. Therefore, the decision whether or not a pharmacological treatment should be set up, and the choice of the drug, need to be tailored to the individual patient, and requires accurate clinical judgment. The specific aspects of frailty and disability, along with the actual age of the patients, have to be considered together, with a comprehensive assessment approach. The present review summarizes the evidence regarding the modifications of cholesterol metabolism in older patients, the impact of lipid‐lowering drugs on cardiovascular outcomes and focuses on the considerations that can help to define the most appropriate treatment strategy, in view of the individual functional profile. Geriatr Gerontol Int 2019; 19: 375–383.

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Section: Cholesterol and Cardiovascular Risk In Older Patientsmentioning

confidence: 97%

Section: Cholesterol and Cardiovascular Risk In Older Patientsmentioning

confidence: 99%

Management of high cholesterol levels in older people

Bertolotti

Lancellotti

Mussi

2019

Geriatrics Gerontology Int

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“…Patients with angina who subsequently had CVD on either abnormal cardiac stress test or cardiac catherization were included, whereas patients with chest pain and negative cardiac chest pain were excluded from the analysis. Patients were considered to be high risk if sdLDL‐C >25 mg/dL or LDL‐C >100 mg/dL . Kaplan‐Meier curves were constructed, and differences between curves were evaluated using the log‐rank test.…”

Section: Methodsmentioning

confidence: 99%

Small Dense Low‐Density Lipoprotein Cholesterol Predicts Cardiovascular Events in Liver Transplant Recipients

et al. 2019

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Cardiovascular disease (CVD) is an important cause of morbidity and mortality after liver transplantation (LT). Although LT is associated with dyslipidemia, particularly atherogenic lipoprotein subparticles, the impact of these subparticles on CVD‐related events is unknown. Therefore, the aim of the current study was to evaluate the impact of small dense (sdLDL‐C) low‐density lipoprotein (LDL) cholesterol (LDL‐C) on CVD events. Prospectively enrolled patients (N = 130) had detailed lipid profile consisting of traditional lipid parameters and sdLDL‐C and were followed for CVD events. The primary endpoint was a CVD composite consisting of myocardial infarction (MI), angina, need for coronary revascularization, and cardiac death. Mean age of the cohort was 58 ± 11 years, and the most common etiology of liver disease (LD) was hepatitis C virus (N = 48) and nonalcoholic steatohepatitis (N = 23). A total of 20 CVD events were noted after median follow‐up of 45 months. The baseline traditional profile was similar in patients with and without CVD events. A serum LDL‐C cutoff of 100 mg/dL was unable to identify individuals at risk of a CVD event (P = 0.86). In contrast, serum concentration of atherogenic sdLDL‐C >25 mg/dL was predictive of CVD events with a hazard ratio of 6.376 (95% confidence interval, 2.65, 15.34; P < 0.001). This relationship was independent of diabetes, hypertension, sex, ethnicity, LD, obesity, and statin use. Conclusion: sdLDL‐C independently predicted CVD events whereas LDL‐C did not. Thus, sdLDL‐C may provide a useful clinical tool in risk stratifying and managing patients after LT.

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“…sdLDL-C level was found to be increased in patients combined with hyperlipidemia [10]. Thus, the level of sdLDL-C is a candidate for a novel risk factor, or a risk marker for atherosclerotic vascular complications such as coronary heart disease [10,11,12]. sdLDL is also currently considered as one of the lipoproteins that leads to the development of cardiovascular disease (CVD) in patients with chronic kidney disease (CKD) [13].…”

Section: Introductionmentioning

confidence: 99%

Markedly Increased Small Dense Low-Density Lipoprotein During Acute Phase in Childhood and Adolescent Nephrotic Syndrome

Sugimoto¹,

Miyazaki²,

Enya³

et al. 2020

Preprint

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Background: Hyperlipidemia is an important characteristic feature of idiopathic nephrotic syndrome (NS) in children. This study was conducted to examine the lipid profiles, including small dense low-density lipoprotein (sdLDL-C), in childhood-onset NS.Methods: This retrospective study enrolled patients diagnosed with initial-onset NS in childhood and adolescence. Study parameters included lipid profiles. The “alternative LDL window” comprises the number and sizes of LDL particles estimated according to non-HDL-C and TG levels.Results: A total of 39 patients were enrolled who exhibited markedly increased lipid abnormalities, including TC, TG, LDL-C, and non-HDL-C levels (TC, 409.7 TC, TG, and sizes of LDL particles estimated as non-HDL-C, 332.3). Of the 39 patients, 32 (82%) were categorized in the area of hyper-TG/-non-HDL levels, which is considered as sdLDL. A positive correlation was found between non-HDL-C and TC (r = 0.96, P < 0.001), TG (r = 0.38, P = 0.018), LDL-C (r = 0.84, P < 0.001), TC/HDL (r = 0.53, P < 0.001), and atherogenic index of plasma (r = 0.42, P = 0.008).Conclusions: Our study demonstrated markedly increased lipid profiles during the acute phase of NS. Evaluation of lipid profiles using the “alternative LDL window” may help understand the state of hyperlipidemia in NS.

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Small dense low‐density lipoprotein cholesterol is a promising biomarker for secondary prevention in older men with stable coronary artery disease

Abstract: sdLDL-C was the most effective predictor of residual risk of future CE in stable coronary artery disease patients using statins and in high-risk coronary artery disease patients with diabetes or hypertriglyceridemia. Geriatr Gerontol Int 2018; 18: 965-972.

Cited by 35 publications

References 26 publications

Management of high cholesterol levels in older people

Management of high cholesterol levels in older people

Small Dense Low‐Density Lipoprotein Cholesterol Predicts Cardiovascular Events in Liver Transplant Recipients

Markedly Increased Small Dense Low-Density Lipoprotein During Acute Phase in Childhood and Adolescent Nephrotic Syndrome

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