Circulation, Vol 88, 2180-2189, Copyright © 1993 by American Heart Association
P Tornvall, P Bavenholm, C Landou, U de Faire and A Hamsten
BACKGROUND. Hypertriglyceridemia is a common metabolic disturbance in men
< 45 years old with myocardial infarction. To further investigate the
relation between triglyceride-rich lipoproteins and severity of coronary
atherosclerosis in this subset of postinfarction patients, apolipoprotein
B-containing lipoproteins of 64 consecutive patients were subfractionated
in connection with coronary angiography. METHODS AND RESULTS.
Density-gradient ultracentrifugation of plasma and coronary angiography
were performed 4 to 6 months after the myocardial infarction. Global
coronary atherosclerosis and the number and severity of distinct stenoses
were evaluated by semiquantitative analysis of 15 proximal coronary
segments. The majority of the patients (60%) were hypertriglyceridemic and
had higher coronary scores than normotriglyceridemic patients. Of the major
plasma lipoproteins, triglycerides and cholesterol in the low-density
lipoprotein (LDL) fraction were associated with global coronary
atherosclerosis, whereas LDL triglycerides and high-density lipoprotein
(HDL) cholesterol correlated directly and inversely, respectively, with the
coronary stenosis score. Plasma apolipoprotein B correlated with both
coronary scores. The plasma concentrations of lipid and protein in the
very-low- density lipoprotein (VLDL) subfractions (VLDL1 through VLDL3) and
intermediate-density lipoprotein (IDL) did not correlate with either of the
coronary scores, whereas the concentration of triglycerides in dense LDL
(density > 1.040 kg/L) was strongly associated with both coronary
scores. Compositional analysis of the smallest VLDL particles (VLDL3) and
IDL revealed a correlation between the number of cholesteryl ester
molecules in small VLDL and global coronary atherosclerosis in
hypertriglyceridemic patients. CONCLUSIONS. Global coronary atherosclerosis
and distinct stenoses in young postinfarction patients are associated with
the number of apolipoprotein B-containing particles in plasma and the
concentration of LDL triglyceride. Specifically, dense triglyceride-rich
LDL particles and, in hypertriglyceridemic patients, small cholesteryl
ester-rich VLDL particles relate to coronary artery disease severity.
ARTICLES
Relation of plasma levels and composition of apolipoprotein B- containing lipoproteins to angiographically defined coronary artery disease in young patients with myocardial infarction
King Gustaf V Research Institute, Karolinska Institute, Stockholm, Sweden.
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