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

Abstract

Background: Small dense LDL-cholesterol is an established risk factor for atherosclerosis but is not routinely measured in daily practice. The association between small dense LDL-cholesterol and triglyceride, which in turn is routinely measured, in patients with acute coronary syndrome remains unknown. Methods: Consecutive patients with acute coronary syndrome who were admitted to our institute were prospectively included, and serum samples were obtained on admission. The association between small dense LDL-cholesterol and triglyceride was investigated. Results: Among 55 patients (median 71 years old, 64% men), median (interquartile range) small dense LDL-cholesterol was 23.6 (17.0, 36.0) and triglyceride was 101 (60, 134) mg/dL. Triglyceride level correlated with small dense LDL-cholesterol (r = 0.67, p < 0.001) and was an independent determinant of small dense LDL-cholesterol together with body mass index (p = 0.010 and p = 0.008, respectively). Those with high triglyceride and high body mass index had a 3-fold level of small dense LDL-cholesterol compared with those with low triglyceride and low body mass index (45.8 [35.0, 54.0] mg/dL versus 15.0 [11.6, 23.7] mg/dL, p = 0.001). Conclusions: Triglyceride level was a major determinant of small dense LDL-cholesterol in patients with acute coronary syndrome. Triglyceride level might be a useful and practical biomarker for risk stratification for patients with acute coronary syndrome together with body mass index.

Impact of Pemafibrate Therapy on Reducing Small Dense Low-Density-Lipoprotein-Cholesterol Levels in Patients with Hypertriglyceridemia

“…The number of small dense LDL-cholesterol particles may theoretically increase along with triglyceride levels, particularly when the level of LDL-cholesterol is high. In the clinical literature, there is a mild-to-moderate correlation between triglyceride levels and actual measured small dense LDL-cholesterol levels [18]. Thus, our finding that pemafibrate decreased small dense LDL-cholesterol levels along with triglyceride levels may not be surprising, although it had not been previously validated [19].…”

“…On the contrary, other variables are also associated with a higher burden of small dense LDL-cholesterol. For example, insulin resistance, which is often seen in patients with metabolic syndrome, can also increase the burden of small dense LDL-cholesterol [21], especially in patients with obesity [18]. A recent study found that pemafibrate improved insulin resistance and maintained beta-cell function, which were correlated with improvement in lipid abnormality [22].…”