LDL containing apolipoprotein CIII is an independent risk factor for coronary events in diabetic patients.
OBJECTIVE
Triglyceride-rich lipoproteins that contain apolipoprotein CIII (apoCIII) are prominent in diabetic dyslipidemia. We hypothesized that these lipoproteins increase coronary disease risk in diabetic patients beyond that caused by standard lipid risk factors.


RESULTS
Diabetic patients with previous myocardial infarction were followed for 5 years, and 121 who had a recurrent coronary event were matched to 121 who did not. VLDL and LDL that contained or did not contain apoCIII (CIII+ or CIII-) were prepared by immunoaffinity chromatography and ultracentrifugation. IDL was included in the LDL fraction. LDL CIII+, rich in cholesterol and triglyceride, was the strongest predictor of coronary events (relative risk [RR] 6.6, P<0.0001, for 4th versus 1st quartile). LDL CIII+ comprised 10% of total LDL. The main type of LDL, LDL CIII-, was less strongly predictive (RR 2.2, P=0.07). The increased risk associated with LDL CIII+ was unaffected by adjustment for plasma lipids, apoB, non-HDL cholesterol, or the other VLDL and LDL types. For VLDL CIII+, RR 0.5, P=0.07; for VLDL CIII-, RR 2.3, P=0.046. The presence of apolipoprotein E with CIII on VLDL and LDL did not affect risk.


CONCLUSIONS
LDL with apoCIII strongly predicts coronary events in diabetic patients independently of other lipids and may be an atherogenic remnant of triglyceride-rich VLDL metabolism.
Lee
Sung-Joon
SJ
Department of Nutrition, Harvard School of Public Health, Boston, Mass 02115, USA.
Campos
Hannia
H
Moye
Lemuel A
LA
Sacks
Frank M
FM
D053305:Apolipoprotein C-III; D001056:Apolipoproteins C / Q000097:blood*; D016022:Case-Control Studies; D002784:Cholesterol / Q000097:blood; D015897:Comorbidity; D003327:Coronary Disease / Q000097:blood / Q000453:epidemiology*; D003920:Diabetes Mellitus / Q000097:blood / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008077:Lipoproteins, LDL / Q000097:blood* / Q000737:chemistry; D008079:Lipoproteins, VLDL / Q000097:blood / Q000737:chemistry; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000453:epidemiology; D017035:Pravastatin / Q000627:therapeutic use; D011446:Prospective Studies; D012008:Recurrence; D012306:Risk; D012307:Risk Factors; D014280:Triglycerides / Q000097:blood
D053305:Apolipoprotein C-III; D001056:Apolipoproteins C; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008077:Lipoproteins, LDL; D008079:Lipoproteins, VLDL; D014280:Triglycerides; D002784:Cholesterol; D017035:Pravastatin