Serum total and high-density lipoprotein phospholipids: independent predictive value for cardiometabolic risk.
OBJECTIVE
Given that serum phospholipids (PL) may serve as inflammation mediators, we studied whether they predicted metabolic syndrome (MetS), type-2 diabetes or coronary heart disease (CHD) risk in people prone to enhanced low-grade inflammation.


METHODS
We analyzed unselected middle-aged Turkish adults with available serum total (n = 852) and HDL-PL (n = 428) measurements and follow-up (mean 6.6 years) by Cox or logistic regression, after exclusion of prevalent cases of outcome disorder. The enzymatic method used measured total content of phosphatidylcholine, sphingomyelin and lyso-phosphatidylcholine.


RESULTS
Most lipid and non-lipid variables were significantly different in the upper two compared with the lowest total PL tertile, whereby apolipoprotein (apo)A-I and HDL-cholesterol were higher (not lower). ApoA-I, HDL-cholesterol and uric acid were uniformly positive independent linear covariates of total and HDL PL, apoA-I even in participants without MetS. After adjustment for sex, age, waist circumference, HDL-cholesterol and systolic blood pressure, logistic regression for incident MetS disclosed a 3-fold risk (RR [95% CI 1.28; 6.81]) in the upper HDL-pl tertile. In Cox regression models, while the combined two higher HDL-pl tertiles significantly protected against CHD risk in males (HR 0.29 [95% CI 0.10; 0.89]), they weakly tended to impart risk in females: upper two total PL tertiles tended to increased risk of diabetes and CHD.


CONCLUSIONS
Excess total PL may mediate inflammatory properties to apoA-I, HDL and uric acid. Excess HDL-pl independently predict risk for MetS in each gender, but are protective against CHD risk in men, possibly because oxidized PL content mediated by total PL is sex-dependent, as reviewed elsewhere.
Department of Cardiology, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey. Electronic address: alt_onat@yahoo.com.tr.
Altan
A
Onat
Department of Cardiology, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey.
H
H
Altuğ Çakmak
Department of Public Health, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey.
Günay
G
Can
Department of Cardiology, Dicle University, Diyarbakir, Turkey.
Murat
M
Yüksel
S. Ersek Center for Cardiovascular Surgery, Istanbul, Turkey.
Bayram
B
Köroğlu
Department of Cardiology, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey.
Hüsniye
H
Yüksel
D001053:Apolipoproteins / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood*; D008076:Cholesterol, HDL / Q000097:blood*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood*; D008875:Middle Aged; D010743:Phospholipids / Q000097:blood*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012307:Risk Factors; D014421:Turkey; D014527:Uric Acid; D055105:Waist Circumference
D001053:Apolipoproteins; D008076:Cholesterol, HDL; D010743:Phospholipids; D014527:Uric Acid
Apolipoprotein A-I; Coronary heart disease risk; HDL-cholesterol; Metabolic syndrome; Phospholipids; Population-based study