title: 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 vs. 7263.94) and had stronger CAC association in individuals with TGs >150 mg/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.
authors.affiliation: Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Stuart B
authors.initials: SB
authors.lastname: Prenner
authors.affiliation: Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Claire K
authors.initials: CK
authors.lastname: Mulvey
authors.affiliation: Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Jane F
authors.initials: JF
authors.lastname: Ferguson
authors.affiliation: Institute for Diabetes, Obesity, and Metabolism, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Rickels
authors.affiliation: Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Anish B
authors.initials: AB
authors.lastname: Bhatt
authors.affiliation: Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. Electronic address: muredach@mail.med.upenn.edu.
authors.forename: Muredach P
authors.initials: MP
authors.lastname: Reilly
mesh_terms: D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology; D001055:Apolipoproteins B / Q000097:blood; D001794:Blood Pressure; D015992:Body Mass Index; D002114:Calcinosis / Q000097:blood* / Q000453:epidemiology; D015243:Cholesterol, VLDL / Q000097:blood*; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000097:blood* / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000188:drug therapy; D005006:Ethnicity; D015444:Exercise; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D006949:Hyperlipidemias / Q000188:drug therapy / Q000453:epidemiology; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010414:Pennsylvania / Q000453:epidemiology; D012307:Risk Factors; D012720:Severity of Illness Index; D012907:Smoking / Q000453:epidemiology; D014280:Triglycerides / Q000097:blood
chemical_list: D001055:Apolipoproteins B; D015243:Cholesterol, VLDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007004:Hypoglycemic Agents; D014280:Triglycerides
keywords: Subclinical atherosclerosis; Triglycerides; VLDL-C
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