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(Circulation. 1998;97:936-937.)
© 1998 American Heart Association, Inc.

Correspondence

Small, Dense LDL Particles and Coagulation

Martin Halle, MD; Aloys Berg, MD; ; Joseph Keul, MD

Center of Internal Medicine, Department of Rehabilitation, Prevention and Sports Medicine, Freiburg University Hospital, Freiburg, Germany

To the Editor:

The Québec Cardiovascular Study has prospectively shown that the presence of an LDL subfraction profile of increased concentrations of small, dense LDL particles is a significant predictor for the development of ischemic heart disease (IHD) within 5 years in a disease-free, male, middle-aged population.¹ Approximately half of the individuals with IHD experienced acute myocardial infarction, whereas the other half developed effort angina. Two major pathophysiological mechanisms are responsible for the development of acute myocardial infarction in these individuals: lipid accumulation in the arterial wall and intracoronary thrombosis.² Although the association between small, dense LDL particles with other lipids and their role in developing IHD by subendothelial lipid accumulation has been discussed in detail,^{1 3} the possible role of the LDL subfraction profile in coagulation has not been addressed. This seems particularly important because individuals who developed IHD had an almost 15% higher incidence of diabetes mellitus at baseline than did those who remained free of disease,¹ and diabetes mellitus is known to be closely associated with increased coagulation, ie, increased fibrinogen levels; and impaired fibrinolysis, ie, elevated plasminogen activator inhibitor-1 concentrations.⁴ Even in nondiabetic, healthy subjects, elevated fibrinogen concentrations >2.9 g/L are associated with increased concentrations of small, dense LDL particles, and 40% of the concentration of small, dense LDL particles can be predicted by serum triglycerides and fibrinogen concentrations alone.⁵ Therefore, it seems important to focus on other factors besides lipids to evaluate the role of small, dense LDL particles in IHD and particularly acute myocardial infarction. . . . [Full Text of this Article]

Benoît Lamarche, PhD; André Tchernof, PhD; ; Jean-Pierre Després, PhD

Lipid Research Center, CHUL Research Center, Sainte-Foy (Québec), Canada

Gilles R. Dagenais, MD

Department of Medicine, University of Montréal, Québec, Canada