Association between plasma lipids, and apolipoproteins and coronary artery disease: a cross-sectional study in a low-risk Korean population

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Abstract

Background

Due to the lower level of the traditional lipid profiles in Koreans than in the series of patients from the western countries, the need to investigate other lipid parameters to help identify the individuals at high risk of CAD has been emphasized.

Aim and methods

To investigate whether apolipoprotein B (apo B), apolipoprotein A-I (apo A-I) and their ratio give additional information to the traditional lipid risk factors for discriminating the individuals at high-risk for coronary artery disease (CAD), 544 subjects, who met the lipid criteria of total cholesterol (TC) <230 mg/dl, low-density lipoprotein cholesterol (LDL-C) <120 mg/dl and high-density lipoprotein cholesterol (HDL-C) >40 mg/dl were recruited. Patients were considered to be CAD(+) if they had ≥50% stenosis in at least one coronary artery.

Results

In men, TC and apo B/apo A-I ratio were significantly different between groups with and without CAD after adjusting for age and diabetes (P=0.037 and 0.035), and in women, triglyceride (TG), HDL-C and apo B/apo A-I ratio were significantly different after adjusting for age, diabetes and smoking status (P=0.006, 0.007 and 0.030, respectively). In the lowest quartile of TC, TG and LDL-C, and the highest quartile of HDL-C, only apo B/apo A-I ratio was associated with CAD in both men and women. The only variable showing a significant difference between patients with and without CAD was apo B/apo A-I ratio. In models assessing whether apolipoproteins give additional information to traditional lipid risk factors, HDL-C, LDL-C, apo B/apo A-I ratio and in women but not in men, TG and apo B were all independent markers for the presence of CAD. Among the nontraditional lipid factors, only apo B/apo A-I ratio showed its additional value for identifying the presence of CAD.

Conclusion

Apo B/apo A-I ratio is the only variable that differentiates the patients with CAD from those without and, furthermore, gives additional information to that supplied by traditional lipid risk factors in a low-risk Korean population.

Introduction

Coronary artery disease (CAD) is one of the most common causes of death in the world [1]. Recently, the change of food intake and lifestyle like the western population has made the prevalence of CAD in Koreans increase progressively [2].

Many studies have proven links between lipid risk factors, low- [3], [4] and high-density lipoprotein cholesterol (LDL-C and HDL-C, respectively) [5], [6], [7] in particular, and CAD. However, because a number of patients with CAD have LDL-C and HDL-C levels within normal range, the ability to identify subjects at high risk for the development of CAD based on the traditional lipid profiles such as LDL-C and HDL-C has been in doubt [8]. Especially, due to the lower level of the traditional lipid profiles in Koreans than in the series of patients from the western countries [9], the need to investigate another lipid parameters, if any, to help identify the individuals at high risk of CAD has been emphasized.

Apolipoprotein B (apo B) and apolipoprotein A-I (apo A-I) have been proposed as nontraditional lipid risk factors, but mixed results have been yielded between apolipoproteins and CAD [10], [11], [12], [13], [14], [15], [16].

Although there are numerous data in an American or European population with high lipid levels, the published data on apo B and apo A-I for CAD in an Asian population with low lipid level are rare.

Thus, the purpose of this study is to elucidate, in a relatively large number of a low-risk Korean population whether apo B, apo A-I and their ratio give additional information to the traditional lipid risk factors for identifying the individuals at high-risk for CAD.

Section snippets

Study population

A total of 956 consecutive patients, who were referred to or visited at Seoul National University Hospital for evaluation of chest pain, were recruited. Coronary angiography (CAG) was performed in all of the patients. Patients with rheumatic valvular disease, prosthetic valves, congenital heart disease, bacterial endocarditis, hypertrophic cardiomyopathy and chronic renal failure were excluded. Patients with plasma lipid levels of TC≥230 mg/dl, LDL-C≥120 mg/dl, HDL-C≤40 mg/dl and TG≥400 mg/dl

Results

There were 192 patients in CAD(−) and 352 patients in CAD(+). The clinical characteristics of 544 patients were presented in Table 1, and the levels of lipids and apolipoproteins were shown in Table 2.

Discussion

We revealed in a low-risk Korean population that plasma apo B/apo A-I ratio was associated with the presence of CAD. As well, apo B/apo A-I ratio gave additional information to that acquired by traditional lipid risk factors in this low-risk population.

Acknowledgements

This study was supported by a research grant to Dr. Hyo-Soo Kim from Korea Science and Engineering Foundation (KOSEF) through the Aging and Apoptosis Research Center at Seoul National University, Seoul, Korea.

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