Circulation, Vol 73, 1097-1110, Copyright © 1986 by American Heart Association
A Hamsten, G Walldius, A Szamosi, G Dahlen and U de Faire
The relationship of serum lipoprotein and apolipoprotein concentrations to
angiographically determined coronary artery disease was investigated in 105
consecutive male survivors of myocardial infarction under the age of 45.
Concentrations and composition of lipoproteins, lipid indexes, and nonlipid
risk factors (tobacco consumption, hypertension, reduced glucose tolerance,
and obesity) were related to a recently developed scoring system for
semiquantitative estimation of diffuse coronary atheromatosis, as well as
to the number and severity of significant coronary artery stenoses. The
concentrations of cholesterol in very low-density lipoprotein (VLDL),
low-density lipoprotein (LDL), and high-density lipoprotein (HDL), in
combination with serum triglyceride or VLDL triglyceride level, comprised
the best set of independent discriminatory lipid variables between patients
and control subjects. In the patients, LDL cholesterol and apolipoprotein B
levels showed strong relationships to the extent and severity of coronary
atheromatosis but not to the number and severity of distinct coronary
stenoses. HDL2 cholesterol concentration correlated inversely with the
coronary atheromatosis score, whereas other variables reflecting HDL
concentration and composition or VLDL lipids were not independently related
to any of the coronary scores. The LDL triglyceride level, an index of
intermediate-density lipoprotein (IDL) accumulation, was significantly
correlated to the coronary atheromatosis score in univariate analysis.
Nonlipid risk factors were correlated neither to coronary atheromatosis nor
to severity of stenoses. Stepwise multiple regression analyses of data
adjusted for age, cumulative tobacco consumption, and weight indicated that
18% of the variation in the coronary atheromatosis score could be accounted
for by levels of apolipoprotein B. Addition of other lipoprotein variables
or the nonlipid variables hypertension and glucose tolerance did not
significantly increase the value of R2. When ratios of lipoprotein lipids
and apolipoproteins were included in the regression model, the highest
multiple correlation coefficient was obtained with the LDL/HDL cholesterol
ratio alone (R2 = .22). The present data demonstrate the importance of
elevated LDL cholesterol and apolipoprotein B concentrations for the
development of coronary atheromatosis in young male survivors of myocardial
infarction. The lack of correlations between the levels of lipoprotein
lipids and serum apolipoproteins and the severity of coronary stenoses
suggests that mechanisms other than disturbances of lipoprotein metabolism
may be involved in the progression of more advanced coronary lesions.
ARTICLES
Relationship of angiographically defined coronary artery disease to serum lipoproteins and apolipoproteins in young survivors of myocardial infarction
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