Utility of high density lipoprotein particle concentration in predicting future major adverse cardiovascular events among patients undergoing angiography.
BACKGROUND
HDL-C is recognized to be inversely associated with cardiovascular (CV) risk. However, attenuation of the association of HDL-C with CV risk may occur after adjustment for other lipoprotein parameters and in various disease states, especially in the setting of acute coronary syndrome (ACS). Recently, the number of HDL particles (HDL-P) has been suggested to improve CV risk prediction.


RESULTS
Patients (n=2999) in the Intermountain Heart Collaborative Study who underwent angiography and had lipoprotein particle measurements determined by nuclear magnetic resonance (NMR) spectroscopy were studied. Multivariable Cox hazard regression was utilized to evaluate the association of HDL-C, HDL-P, and HDL-P subclasses with future major adverse CV events (MACE: death, myocardial infarction, heart failure, and stroke). Patients averaged 64±12years, 66% male, 26% diabetic, and 42% ACS. At angiography, 65% of patients were diagnosed with coronary artery disease (CAD). HDL-C and HDL-P averaged 41±13mg/dL and 28±8μmol/L, respectively. HDL-P (HR=0.903, p=0.001), but not HDL-C (HR=0.947, p=0.102) was significantly associated with MACE. In a model that included all HDL-P subclasses, both small (HR=0.862, p<0.0001) and medium (HR=0.922, p=0.020) were associated with CV risk, but not large HDL-P (HR=1.0042, p=0.185). Small HDL-P continued to be associated with all of the individual components of MACE, but not stroke.


CONCLUSIONS
In this study of patients undergoing angiography, HDL-P was a strong, independent predictor of future MACE, with the smaller HDL-P accounting for this association.
Intermountain Medical Center, 5121 S Cottonwood St, Murray, UT, USA. Electronic address: heidi.may@imail.org.
Heidi T
HT
May
Intermountain Medical Center, 5121 S Cottonwood St, Murray, UT, USA; University of Utah, 30 N 1900 E, Salt Lake City, UT, USA.
Jeffrey L
JL
Anderson
LipoScience, Laboratory Corporation of America® Holdings, 2500 Sumner Blvd, Raleigh, NC, USA.
Deborah A
DA
Winegar
Intermountain Medical Center, 5121 S Cottonwood St, Murray, UT, USA.
Jeffrey
J
Rollo
LipoScience, Laboratory Corporation of America® Holdings, 2500 Sumner Blvd, Raleigh, NC, USA.
Margery A
MA
Connelly
LipoScience, Laboratory Corporation of America® Holdings, 2500 Sumner Blvd, Raleigh, NC, USA.
James D
JD
Otvos
Intermountain Medical Center, 5121 S Cottonwood St, Murray, UT, USA; University of Utah, 30 N 1900 E, Salt Lake City, UT, USA.
Joseph B
JB
Muhlestein
D000368:Aged; D000792:Angiography / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000097:blood*; D008076:Cholesterol, HDL / Q000097:blood*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged
D008076:Cholesterol, HDL
Cardiovascular risk; Lipids; Outcomes