Abstract 10909: LDL and HDL Particle vs. Cholesterol Concentration in Metabolic Syndrome and Diabetes for the Prediction of Coronary Heart Disease: The Multiethnic Study of Atherosclerosis
Background: A more important role of both low and density lipoprotein (LDL-P and HDL-P) than cholesterol (LDL-C and HDL-C) concentration in predicting coronary heart disease (CHD) has been noted. However, the role of these factors and extent of particle-cholesterol discordance in metabolic syndrome (MetS) and diabetes (DM) for event prediction is unknown.
Methods: In adults aged 45-84 from the Multi-Ethnic Study of Atherosclerosis, a prospective study of subjects without baseline cardiovascular disease, we defined percent discordance of LDL and HDL based on a subject’s difference between baseline particle and cholesterol percentiles. Separate Cox regressions adjusted for standard risk factors were performed to assess the relationship of the continuous lipoprotein discordance variables, as well as LDL-C, LDL-P, HDL-C, and HDL-P, to incident CHD events in those with DM, MetS (without DM), or neither condition.
Results: Among 6,417 subjects (52.5% male, mean age 62.1) with 10 year follow-up, those with DM and MetS had significantly greater LDL and HDL discordance compared to those without these conditions (Figure). In discordance models, only LDL discordance [per standard deviation (SD)] within the MetS group was positively associated with CHD events [Hazard Ratio (HR) =1.25, p<0.01]. In models with individual particle/cholesterol variables (per SD), within the DM group, HDL-P was negatively (HR=0.71, p<0.05) and LDL-C positively (HR=1.47, p<0.05) associated with CHD. In those with MetS, only LDL-P was positively associated with CHD (HR=1.34, p<0.05). In those with neither disease, only LDL-C was positively associated with CHD (HR=1.27, p<0.05).
Conclusion: LDL discordance (mainly through higher LDL-P) in those with MetS and higher LDL-C with lower HDL-P in those with DM predicts CHD risk. These results support a potential role for examining lipoprotein particles and discordances in persons with MetS and DM to better assess CHD risk.
Author Disclosures: D.M. Tehrani: None. Y. Zhao: None. M. Blaha: None. S. Mora: None. R. Mackey: None. E. Michos: None. M. Budoff: Research Grant; Significant; NIH. Other Research Support; Significant; GE. W. Cromwell: Employment; Significant; Liposcience. J. Otvos: Employment; Significant; Liposcience. P. Rosenblit: Research Grant; Significant; Amgen, Bristol Myers Squibb, DexCom, Eli Lilly, Mannkind, Merck, Novo Nordisk, Orexigen, Pfizer, Sanofi. Speakers Bureau; Significant; Abbvie, Amarin, Astra Zeneca/BMS, BI/Lilly, GSK, Janseen, KOWA, Merck, NovoNordisk, Takeda. Consultant/Advisory Board; Significant; Amarin, Janssen, Lilly, Sanofi-Regeneron. N. Wong: None.
- © 2015 by American Heart Association, Inc.