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Background: High-density lipoprotein (HDL) and inflammation are risk factors for coronary artery disease (CAD). There are very limited data evaluating the role of HDL sub-particles HDL2 and HDL3 for assessing severity of CAD in patients on statin and 325mg/day aspirin therapy. We aim to identify if HDL-cholesterol particle subtypes are more predictive of CAD than total-HDL in this patient population and also to determine whether lipid levels are associated with inflammation marked by thromboxane generation.
Methods: Blood samples were obtained immediately prior to cardiac catheterization in 304 consecutive patients with suspected CAD on statin therapy. Detailed lipid profiling, urinary 11- dehydrothromboxane B2 (11-dh- TxB2) and oxidized LDL (ox-LDL) were analyzed using VAP cholesterol test, AspirinWorks TM ELISA assay and Mercodia OxLDL ELISA Test kit, respectively. CAD severity was angiographically defined as severe CAD (>75% luminal diameter stenosis [LDS]) and non-severe CAD (≤ 75% LDS). Multiple regression analysis was performed to test for statistical significance. Receiver operator curve (ROC) analysis was performed to determine cut-point for predicting severe CAD.
Results: Patients with severe CAD had a significantly lower total-HDL, lower HDL3 and higher lipoprotein (a) levels (Table 1). HDL3 and lipoprotein (a) retained statistical significance on multiple regression analysis. ROC analysis showed a HDL3 to have C-statistic of 0.60 (criterion ≤ 33 mg/dL, sensitivity =60%, specificity=58%; p=0.003) and lipoprotein (a) to have C-statistic of 0.61 (criterion > 7 mg/dL, sensitivity =51%, specificity=74%; p=0.0007). Patients with HDL3 ≤33 mg/dL were found to have significantly elevated urinary 11-dehydrothromboxane B2 (1564.7 ± 1674.1 vs. 1101.4 ± 562.2 pg/mg creatinine, p=0.02) and ox-LDL (41.1±15.0 vs. 35.4 ± 11.8 U/L, p=0.002).
Conclusions: In patients on statin therapy, HDL3 and lipoprotein (a) improve the prediction of severe CAD compared to a traditional lipid panel. In addition, patients with HDL3 ≤33 mg/dl have greater inflammation marked by 11-dh-txb2 and ox-LDL. Further studies are needed to evaluate the utility of these novel biomarkers in predicting CAD severity.
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Advances in Lipid Management
Abstract Category: 3. Acute and Stable Ischemic Heart Disease: Therapy
Presentation Number: 1203-303
- 2017 American College of Cardiology Foundation