Abstract 18745: Triglyceride-Rich High-Density Lipoprotein Composition as Residual Risk Biomarker of Coronary Artery Disease Including Reduced eGFR and Pre-diabetes

Abstract

Beyond LDL, HDL is the urgent target for atherosclerosis; few data exist regarding how compositional changes in HDL can affect coronary artery disease in which the anti-atherogenic quality of HDL is not simply defined by the plasma HDL-C level. Therefore, we determine the roles of HDL composition, closely related with VLDL metabolism, in angiographically evaluated coronary artery disease.

Methods: A total of 365 patients (202 males, mean age of 58±13) suspected coronary artery disease were enrolled, and coronary stenosis index (CSI) was estimated with angiography in 210 patients (134 males, mean age of 61 ± 11). Fasting lipid profiles without lipid drugs at least 4 weeks were analyzed by ultracentrifugation, and free cholesterol, cholesterol ester, triglycerides (TG) and phospholipids (PL) levels in each fraction were determined. Pre-diabetes was defined as fasting glucose 110-125 mg/dL or impaired glucose tolerance with 75gOGTT.

Results: Mean CSI was 10.8 and median was 8.0. CSI showed weak positive association with plasma TG (p<0.05, R² 2%), and negative association with HDL-C (p<0.01, R² 5%). In HDL composition, HDL-TG/PL ratio showed strong positive association with CSI (p<0.0001, R² 8%) and number of coronary vessel with significant (>75%) stenosis (p<0.0005, R² 6%). HDL-TG itself was weakly associated with CSI (p<0.05, R² 2%). HDL-TG/PL was positively associated with CETP mass (p<0.01, R² 5%). HDL-TG/PL showed no gender difference. CSI did not show significant association with LDL-C in this study; presumably most of patients with high LDL-C levels had been treated with statins already. CSI showed strong negative associattion with eGFR (p<0.0005, R² 9%). eGFR showed weak negative association with HDL-C, but positive association with HDL-TG/PL (both p<0.05). Pre-diabetes patients showed higher CSI than normal group (14.7±13 vs. 8.9±9, p<0.005), and also higher HDL-TG/PL (p<0.05).

Conclusion: We propose HDL-TG/PL as residual risk biomarker also reflecting chronic kidney disease and pre-diabetes beyond LDL-C.