The possible role of Remnant Lipoproteins as a risk factor for Sudden Cardiac Death

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Postmortem plasma lipid and lipoprotein analyzes were conducted in two groups of Japanese subjects who died suddenly and unexpectedly due to cardiac (n=93) or non-cardiac (n=26) cases. No individuals in either group had a significant medical or cardiac history. In this study, we measured plasma total cholesterol, triglyceride, VLDL-cholesterol, LDL-cholesterol, HDL-cholesterol, and especially lipoprotein remnants. Triglyceride and apo E rich remnant-like particles (RLP) have been studied here as a possible risk factor for sudden cardiac death. Plasma RLP-cholesterol (RLP-C) and RLP-triglyceride (RLP-TG) values in relation to the progression of coronary atherosclerosis and to the risk for sudden cardiac death were also studied. The receiver-operating characteristic curve (ROC) analysis showed that RLP-TG was the most significant risk factor for sudden cardiac death among the lipids and lipoproteins and RLP-C was the greatest predictor for coronary atherosclerosis. HDL-C and LDL-C levels were within normal limits in the majority of the cases and did not appear to relate to the sudden cardiac death. Apo E phenotyping was performed for the detection of genetic back ground in the lipid metabolism. The frequency of Apo E 3/3 (wild type) phenotype which closely relates with the remnant metabolism was significantly reduced in the sudden cardiac death group. These results suggest that elevated RLP-C and RLP-TG levels are more prevalent in coronary atherosclerosis and sudden cardiac death, and may be better predictors of these events.