Abstract 16886: LDL4- a Novel Predictor of Coronary Artery Disease Severity
Background: Hypercholesterolemia is a well-established risk factor for coronary artery disease (CAD). There is a growing focus on preventive cardiology through identification of patients at high risk for CAD. CAD is frequently noted in patients with elevated cholesterol levels but patients with normal levels of total cholesterol and LDL-C are also noted to have CAD including severe CAD. Small-dense LDL particle subtypes (LDL3 and LDL4) have been found to be more oxidizable and atherogenic. We aim to identify if cholesterol particle subtypes are more predictive of CAD than standard lipid testing.
Methods: Blood samples were obtained immediately prior to cardiac catheterization in patients with suspected CAD. Detailed lipid profiling was performed using VAP cholesterol test and AtherOx testing was performed using immunoassay in patients not on lipid lowering therapy. 138 patients had CAD severity categorized angiographically as none/minor CAD (less than 20% luminal diameter stenosis [LDS]), and severe CAD (more than 75% LDS of any major coronary vessel).
Results: Patients with severe CAD had a significantly higher LDL4, higher triglycerides, and lower total HDL, HDL2, HDL3 as compared to patients with none/minor CAD (Table). A higher number of patients in the severe disease group demonstrated LDL cholesterol density pattern B. By ROC analysis a cutpoint of >12.7 mg/dl (AUC=0.63, p=0.006) and ≤ 45 mg/dl (AUC=0.64, p<0.0001) was most predictive of severe CAD by LDL4 and HDL, respectively.
Conclusion: This is the first report of the relation of LDL subtype to angiographic disease severity. Total cholesterol and total LDL, common components of the basic lipid panel failed to identify patients with severe CAD undergoing catheterization. LDL 4 was identified in our study as a novel marker along with HDL of disease severity. LDL4 may serve as a future measurement to enhance personalization of statin therapy.
Author Disclosures: K.P. Bliden: None. U.S. Tantry: None. S. Pandya: None. R. Rafeedheen: None. P.P. Toth: None. A. Tabrichzi: None. C. Cummings: None. C. Franzese: None. M. Gesheff: None. P.A. Gurbel: Research Grant; Modest; Accumetrics. Research Grant; Significant; National Institutes of Health, Daiichi Sankyo/Lilly, CSL, AstraZeneca, , Harvard Clinical Research Institute, Bayer, Haemonetics and Duke Clinical Research Institute, Sinnowa, Coramed, Multiplate. Speakers Bureau; Significant; AstraZeneca, Daiichi Sankyo/ Lilly, Merck. Honoraria; Modest; Boehringer Ingleheim. Honoraria; Significant; AstraZeneca, Daiichi Sankyo/ Lilly, Merck. Consultant/Advisory Board; Significant; AstraZeneca, Daiichi Sankyo/ Lilly, Merck, Accumetrics,.
- © 2014 by American Heart Association, Inc.