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CLINICAL RESEARCH: TRIGLYCERIDES AND RISK

Prognostic value of remnant-like lipoprotein particle levels in patients with coronary artery disease and type ii diabetes mellitus

Hironobu Fukushima, MD^*, Seigo Sugiyama, MD, PhD^*, Osamu Honda, MD^*, Shunichi Koide, MD^*, Shinichi Nakamura, MD^*, Tomohiro Sakamoto, MD, PhD^*, Michihiro Yoshimura, MD, PhD^*, Hisao Ogawa, MD, PhD^*, Daisuke Fujioka, MD and Kiyotaka Kugiyama, MD, PhD^,*

Department of Internal Medicine II, Yamanashi University, Faculty of Medicine, Yamanashi, Japan
^* Department of Cardiovascular Medicine, Kumamoto University School of Medicine, Kumamoto, Japan

Manuscript received January 6, 2003; revised manuscript received September 22, 2003, accepted September 29, 2003.

^* Reprint requests and correspondence: Dr. Kiyotaka Kugiyama, Second Department of Internal Medicine, Yamanashi University, Faculty of Medicine, 1110 Shimokato, Tamaho-cho, Nakakomagun, Yamanashi 409-3898 Japan.
kugiyama{at}yamanashi.ac.jp

OBJECTIVES: This study prospectively examined whether the levels of high remnant-like lipoprotein particles (RLP) cholesterol have a significant risk and influence prognosis in patients with coronary artery disease (CAD) and type II diabetes mellitus (DM).

BACKGROUND: Several studies have shown that triglyceride-rich lipoproteins contribute to atherosclerotic complications in type II DM. However, it remains to be established which triglyceride-rich lipoproteins contribute to this risk.

METHODS: Levels of RLP cholesterol in fasting serum were measured by an immunoseparation method in 240 type II DM patients with (n = 120) or without (n = 120) CAD. The patients with CAD were followed up for a period of 24 months until the occurrence of one of the following clinical coronary events: re-admission or coronary revascularization due to recurrent or refractory angina pectoris, nonfatal myocardial infarction, or cardiac death.

RESULTS: Patients with CAD had higher RLP levels than patients without CAD. Multivariate logistic regression analysis showed that high RLP cholesterol levels (>4.7 mg cholesterol/dl, representing the 75th percentile of the distribution of RLP cholesterol levels in control subjects) were a significant risk factor for the presence of CAD, independent of traditional risk factors. Kaplan-Meier analysis demonstrated that higher RLP cholesterol levels in patients with CAD resulted in a significantly higher probability for the development of coronary events. Multivariate Cox hazards analysis showed that high RLP cholesterol levels in patients with CAD were a significant predictor of future coronary events, independent of other risk factors.

CONCLUSIONS: Increased levels of RLP cholesterol are a significant and independent risk factor of CAD and predict future coronary events in patients with CAD and type II DM.

Abbreviations and Acronyms   apo = apolipoprotein   CABG = coronary artery bypass graft surgery   CAD = coronary artery disease   DM = diabetes mellitus   HbA1c = glycosylated hemoglobin   HDL = high-density lipoprotein   LDL = low-density lipoprotein   PCI = percutaneous coronary intervention   RLP = remnant-like lipoprotein particles   VLDL = very-low-density lipoprotein

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