Abstract 19135: Small, Dense LDL Has Protective Association for Long-Term Mortality After Myocardial Infarction Compared With Large, Buoyant LDL Particles: Insights From the TRIUMPH Study
Introduction: Small dense LDL particles are associated with stronger risk for incident coronary heart disease (CHD) than large buoyant LDL particles. Whether small dense LDL particles are associated with higher risk for long-term mortality after MI than large buoyant LDL particles is unknown.
Methods: LDL pattern [A (large, buoyant), A/B (mixed) and B (small, dense)] was established by ultracentrifugation during MI hospitalization using a Vertical Auto Profile in 2476 patients from 24-sites. Within LDL patterns, we examined patient characteristics and 5-year mortality risk after adjusting for GRACE score, gender, race, BMI, insured status, HTN, diabetes, metabolic syndrome (MetS), current smoking, alcohol abuse, random blood glucose, hs-CRP, MI type (STEMI vs NSTEMI) and in hospital CABG using a Cox hazards model. To assess if treatment would modify the association, we examined interactions by statin and by any lipid lowering therapy (LLT) use at hospital discharge.
Results: Patterns A, A/B and B were present in 39%, 28% and 33%, respectively. Compared with pattern A, patients with B or A/B patterns were younger, more likely to present with STEMI, had lower hs-CRP levels and lower GRACE score (suggesting lower 6 month mortality risk), and higher LDL-C levels, but no significant difference in prevalent diabetes or MetS. Patients with LDL patterns A/B and B had better survival than those with pattern A (Figure). In the multivariable model, the HRs (95% CI) for death in patients with LDL patterns A/B and B compared to pattern A were 0.80 (0.63, 1.01) and 0.66 (0.50, 0.86) (p for trend <0.01), respectively. There was no significant interaction by statin or any LLT use (p for interaction 0.91 and 0.80, respectively).
Conclusions: Contrary to our hypothesis, patients with small, dense LDL have lower long-term mortality after MI than those with large, buoyant LDL particles, irrespective of treatment. Future research is needed to understand this paradoxical finding.
Author Disclosures: B. Bhardwaj: None. Y. Pokharel: Other; Significant; supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under Award Number T32HL110837. Y. Tang: None. A. Towheed: None. M. Qintar: Other; Significant; supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under Award Number T32HL110837.. K. Kulkarni: None. S. Martin: Honoraria; Modest; Abbott Nutrition, American College of Cardiology, Pew Research Center, Quest Diagnostics, Sanofi-Regeneron, Regeneron, Pressed Juicery. S. Virani: None. J. Spertus: Other; Significant; The primary investigator of a contract from the ACCF to analyze the NCDR data. An equity interest in Health Outcomes Sciences..
- © 2016 by American Heart Association, Inc.