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.
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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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