Very low density lipoprotein cholesterol associates with coronary artery calcification in type 2 diabetes beyond circulating levels of triglycerides

Abstract

Objective While recent genomic studies have focused attention on triglyceride (TG) rich lipoproteins in cardiovascular disease (CVD), little is known of very low-density lipoprotein cholesterol (VLDL-C) relationship with atherosclerosis and CVD. We examined, in a high-risk type-2 diabetic population, the association of plasma VLDL-C with coronary artery calcification (CAC). Methods The Penn Diabetes Heart Study (PDHS) is a cross-sectional study of CVD risk factors in type-2 diabetics (n=2118, mean age 59.1 years, 36.5% female, 34.1% Black). Plasma lipids including VLDL-C were calculated (n=1879) after ultracentrifugation. Results In Tobit regression, VLDL-C levels were positively associated with increasing CAC after adjusting for age, race, gender, Framingham risk score, body mass index, C-reactive protein, exercise, medication and alcohol use, hemoglobin A1c, and diabetes duration [Tobit ratio (TR) and 95% confidence interval (CI) 0.38 (0.12–0.65), P=0.005] and even after inclusion of apolipoprotein B data [TR 0.31 (0.03–0.58), P=0.030]. Approximately 3-fold stronger effect was observed in women [TR 0.75 (0.16 – 1.34), P=0.013] than men [TR 0.20 (−0.10–0.50), P=0.189; gender interaction P=0.034]. Plasma VLDL-C was related more strongly to CAC scores than TG levels (e.g., Akaike information criteria of 7263.65 v. 7263.94) and had stronger CAC association in individuals with TGs >150mg/dl (TR 0.80, P=0.010) vs. those with TGs <150 mg/dl (TR 0.27, P=0.185). Conclusions In PDHS, VLDL-C is associated with CAC independent of established CVD risk factors, particularly in women, and may have value even beyond apolipoprotein B levels and in patients with elevated TGs.

Análise do extrato aquoso de Arachis hipoagea L. no combate à dislipidemia e ao ganho ponderal de ratos Wistar submetidos à dieta hiperlipídica1

“…Resultados similares foram relatados por Khalid & Siddiqui (2012), os quais ao empregarem em ratos Wistar (submetidos a uma dieta hiperlipídica) o extrato aquoso de uma planta (Punarnava) também rica em flavonóides, polifenóis e antioxidantes, assim como o EAA, obtiverem uma redução nos níveis de gordura corporal (Prenner et al 2014).…”

What is it about very low density lipoproteins (VLDL) and cardiovascular disease in patients with type 2 diabetes mellitus: Is it the triglycerides or the cholesterol?

“…So then why would levels of VLDL cholesterol (VLDL-C) solve this quandary? Perhaps it's all cholesterol not triglycerides, and this is examined in the Penn Diabetes Heart Study (PDHS) cohort and published by Prenner et al in a previous issue of Atherosclerosis [22].…”

“…So then why would levels of VLDL cholesterol (VLDL-C) solve this quandary? Perhaps it's all cholesterol not triglycerides, and this is examined in the Penn Diabetes Heart Study (PDHS) cohort and published by Prenner et al in a previous issue of Atherosclerosis [22].Plasma apo B-100 represents pro-atherogenic particles, and noteworthy in the Prenner et al paper is the substantial weakening of the relationship between VLDL-C and coronary artery calcification (CAC) noted in the multi-adjusted Model 3 (full sample, p ¼ 0.005) when apo B was included in Model 4 (p ¼ 0.03). Because IDL and VLDL remnants would be expected to contribute a relatively small amount of apo B-100 [8], it must be assumed that this reduction in the strength of association of VLDL-C and CAC must be from LDL; unfortunately LDL-C was not co-varied in a similar manner.…”

Association of very Low-density Lipoprotein Cholesterol with All-cause and Cardiovascular Mortality in Peritoneal Dialysis

“…VLDLs are the major component and atherogenic particles of TGRL in the circulation. A PDHS study that examined VLDL-C as an alternative marker of TGRL demonstrated that VLDL-C levels are positively associated with increased coronary artery calcification in patients with type 2 diabetes even after adjusting for traditional risk factors [18]. Laakso et al also reported that higher VLDL-C levels are associated with an increased risk of CVD in diabetic patients [29].…”

“…Very low-density lipoprotein (VLDL) is the most atherogenic TGRL particles, and the measurement of VLDL-C is relatively straightforward and captures distinct aspects of the TGRL and serum TG [17]. A large cross-sectional study (Penn Diabetes Heart Study (PDHS)) found that higher VLDL-C levels were associated with increasing coronary artery calcification (CAC) after adjusting for numerous traditional CV risk factors in patients with type 2 diabetes [18]. …”