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(Circulation. 1999;99:2858-2860.)
© 1999 American Heart Association, Inc.
Brief Rapid Communications |
Remnant Lipoprotein Levels in Fasting Serum Predict Coronary Events in Patients With Coronary Artery Disease
From the Department of Cardiovascular Medicine, Kumamoto University School of Medicine (K.K., H.D., K.T., H.K., H.S., Y.M., R.T., T.S., H.O., S.S., M.Y., H.Y.), Kumamoto, Japan, and Japan Immunoresearch laboratories (T.N., K.N.), Takasaki, Japan.
Correspondence to Kiyotaka Kugiyama, MD, PhD, Department of Cardiovascular Medicine, Kumamoto University School of Medicine, Honjo 1-1-1, Kumamoto City, Japan 860-8556. E-mail kiyo{at}gpo.kumamoto-u.ac.jp
Background—Remnant lipoproteins are atherogenic, but assays of remnants have not been available in routine clinical laboratories because of the lack of practical and validated methods. A simple and reliable method for such an assay, using an immunochemical approach, has recently been developed. This study prospectively examined whether remnant lipoprotein levels in fasting serum, measured by our method, may have prognostic value in patients with coronary artery disease (CAD).
Methods and Results—Remnant lipoprotein levels in fasting serum
were measured in 135 patients with CAD by an immunoaffinity mixed gel
containing anti-apolipoprotein (apo) A-1 and anti–apoB-100 monoclonal
antibodies. Patients were followed up for 
36 months until occurrence
of 1 of the following clinical coronary events: recurrent or
refractory angina pectoris requiring coronary
revascularization, nonfatal myocardial infarction,
or cardiac death. Kaplan-Meier analysis demonstrated a
significantly higher probability of developing coronary events
in patients with the highest tertile of remnant levels (>5.1 mg
cholesterol/dL; 75th percentile of distribution of remnant
levels) than in those with the lowest tertile of remnant levels (3.3
mg cholesterol/dL; 50th percentile of the distribution).
Higher levels of remnants were a significant and independent predictor
of developing coronary events in multivariate
Cox hazard analysis including the following covariates: extent
of coronary artery stenosis, age, sex, smoking,
hypertension, diabetes mellitus,
hypercholesterolemia, low HDL
cholesterol, and
hypertriglyceridemia.
Conclusions—Higher levels of remnant lipoproteins in fasting serum predict future coronary events in patients with CAD independently of other risk factors. Thus, measurement of fasting remnant levels, assessed by the current immunoseparation method, may be helpful in assessment of CAD risk.
Key Words: atherosclerosis • coronary disease • lipoproteins • prognosis • risk factors
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