Chaudhary Rahul, Kinderytė Marija, Chaudhary Rohit, Sukhi Ajaypaul, Bliden Kevin, Tantry Udaya, Gurbel Paul
Sinai Hospital of Baltimore, Baltimore, MD, USA.
Inova Center for Thrombosis Research and Drug Development, Inova Heart and Vascular Institute, Falls Church FVA, USA.
Cardiovasc Revasc Med. 2019 Nov;20(11):1001-1006. doi: 10.1016/j.carrev.2018.12.019. Epub 2018 Dec 27.
Low high-density lipoprotein (HDL-C) and inflammation are risk factors for coronary artery disease (CAD). However, limited data are available determining the role of HDL-C sub-particles HDL-C and HDL-C for assessing CAD severity in patients on statin therapy.
Blood samples were obtained prior to cardiac catheterization in 304 consecutive patients with suspected CAD on statin therapy in this sub-analysis of Multi-Analyte, thrombogenic, and Genetic Markers of Atherosclerosis (MAGMA, NCT01276678) study. Detailed lipid profiling and oxidized LDL (ox-LDL) were analyzed. CAD severity was angiographically defined as severe CAD (>75% luminal diameter stenosis [LDS]) and non-severe CAD (≤75% LDS). Multi-regression analysis was performed to test for statistical significance. Receiver operator curve (ROC) analysis was performed to determine cut-point for predicting severe CAD.
Patients with severe CAD had a significantly lower total-HDL-C, lower HDL-C and higher lipoprotein(a) levels. HDL-C and lipoprotein(a) cholesterol [Lp(a)-C] retained statistical significance on multiple regression analysis. ROC analysis showed HDL-C to have a C-statistic of 0.60 (p = 0.003) and Lp(a)-C to have a C-statistic of 0.61 (p = 0.0007). Patients with HDL-C ≤ 33 mg/dL and Lp(a)-C > 7 mg/dL were found to have significantly elevated ox-LDL levels.
In patients on statin therapy, HDL-C and Lp(a)-C improve prediction of severe CAD compared to a traditional lipid panel. In addition, patients with HDL-C ≤ 33 mg/dL and Lp(a)-C > 7 mg/dL have greater inflammation marked by ox-LDL. Further studies are needed to evaluate the utility of these novel biomarkers in predicting CAD severity.
低高密度脂蛋白胆固醇（HDL-C）和炎症是冠状动脉疾病（CAD）的危险因素。然而，关于HDL-C亚颗粒在评估接受他汀类药物治疗患者的CAD严重程度方面作用的数据有限。
在多分析、血栓形成和动脉粥样硬化遗传标记（MAGMA，NCT01276678）研究的该亚组分析中，对304例接受他汀类药物治疗且疑似CAD的连续患者在进行心导管检查前采集血样。分析详细的血脂谱和氧化型低密度脂蛋白（ox-LDL）。CAD严重程度通过血管造影定义为重度CAD（管腔直径狭窄[LDS]＞75%）和非重度CAD（LDS≤75%）。进行多元回归分析以检验统计学显著性。进行受试者操作特征曲线（ROC）分析以确定预测重度CAD的切点。
重度CAD患者的总HDL-C显著更低、HDL-C更低且脂蛋白（a）水平更高。HDL-C和脂蛋白（a）胆固醇[Lp（a）-C]在多元回归分析中保持统计学显著性。ROC分析显示HDL-C的C统计量为0.60（p = 0.003），Lp（a）-C的C统计量为0.61（p = 0.0007）。发现HDL-C≤33mg/dL且Lp（a）-C＞7mg/dL的患者ox-LDL水平显著升高。
在接受他汀类药物治疗的患者中，与传统血脂指标相比，HDL-C和Lp（a）-C能更好地预测重度CAD。此外，HDL-C≤33mg/dL且Lp（a）-C＞7mg/dL的患者以ox-LDL为标志的炎症更严重。需要进一步研究来评估这些新型生物标志物在预测CAD严重程度方面的效用。
