title: Discordance of Low-Density Lipoprotein and High-Density Lipoprotein Cholesterol Particle Versus Cholesterol Concentration for the Prediction of Cardiovascular Disease in Patients With Metabolic Syndrome and Diabetes Mellitus (from the Multi-Ethnic Study of Atherosclerosis [MESA]).
abstract: A stronger association for low-density lipoprotein particle (LDL-P) and high-density lipoprotein particle (HDL-P) versus cholesterol concentrations (LDL-C and HDL-C) in predicting coronary heart disease (CHD) has been noted. We evaluate the role of these factors and extent of particle-cholesterol discordance in those with diabetes mellitus (DM) and metabolic syndrome (MetS) for event prediction. In the Multi-Ethnic Study of Atherosclerosis, we examined discordance of LDL and HDL (defined as a subject's difference between baseline particle and cholesterol percentiles), LDL-C, LDL-P, HDL-C, and HDL-P in relation to incident CHD and cardiovascular disease (CVD) events in subjects with DM, MetS (without DM), or neither condition using Cox regression. Of the 6,417 subjects with 10-year follow-up, those with MetS (n = 1,596) and DM (n = 838) had significantly greater LDL and HDL discordance compared with those without these conditions. In discordance models, only LDL discordance (per SD) within the MetS group was positively associated with CHD events (adjusted hazard ratio [HR] = 1.22, 95% confidence interval [CI] 1.01 to 1.48, p <0.05). In models with individual particle/cholesterol variables (per SD), within the DM group, HDL-P was inversely (HR 0.71, 95% CI 0.52 to 0.96, p <0.05) and LDL-C positively (HR 1.47, 95% CI 1.07 to 2.03, p <0.05) associated with CHD. In those with MetS, only LDL-P was positively associated with CHD (HR 1.34, 95% CI 1.00 to 1.78, p <0.05). Similar findings were also seen for CVD. LDL discordance and higher LDL-P in MetS, and higher LDL-C and lower HDL-P in DM, predict CHD and CVD, supporting a potential role for examining lipoprotein particles and discordances in those with MetS and DM.
authors.affiliation: Department of Medicine, University of Chicago Medical Center, Chicago, Illinois.
authors.forename: David M
authors.initials: DM
authors.lastname: Tehrani
authors.affiliation: Department of Epidemiology, University of California Los Angeles, Los Angeles, California.
authors.forename: Yanglu
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Blaha
authors.affiliation: The Center for Cardiovascular Disease Prevention, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Samia
authors.initials: S
authors.lastname: Mora
authors.affiliation: Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Rachel H
authors.initials: RH
authors.lastname: Mackey
authors.affiliation: Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland.
authors.forename: Erin D
authors.initials: ED
authors.lastname: Michos
authors.affiliation: Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, California.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Budoff
authors.affiliation: Lipoprotein and Metabolic Disorders Institute, Raleigh, North Carolina.
authors.forename: William
authors.initials: W
authors.lastname: Cromwell
authors.affiliation: LipoScience, Inc., Raleigh, North Carolina.
authors.forename: James D
authors.initials: JD
authors.lastname: Otvos
authors.affiliation: Diabetes/Lipid Management & Research Center, Huntington Beach, California.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Rosenblit
authors.affiliation: Heart Disease Prevention Program, Division of Cardiology, University of California, Irvine, California. Electronic address: ndwong@uci.edu.
authors.forename: Nathan D
authors.initials: ND
authors.lastname: Wong
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000097:blood / Q000150:complications / Q000208:ethnology*; D015415:Biomarkers / Q000097:blood; D002784:Cholesterol / Q000097:blood*; D008076:Cholesterol, HDL / Q000097:blood*; D008078:Cholesterol, LDL / Q000097:blood*; D003920:Diabetes Mellitus / Q000097:blood* / Q000208:ethnology; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood* / Q000150:complications / Q000208:ethnology; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D002784:Cholesterol