Clinical significance of remnant lipoproteinemia as a therapeutic target of cardiovascular diseases

点击翻译按钮获取中文摘要

This study aimed to determine whether elevated levels of remnant lipoprotein, an atherogenic triglyceride-rich lipoprotein, might be associated with coronary artery disease (CAD), endothelial vasomotor dysfunction, and future stroke in metabolic syndrome. The fasting serum levels of remnant lipoproteins (remnant-like lipoprotein particles cholesterol ; RLP-C) were measured by an immunoseparation method in 210 patients with metabolic syndrome meeting ATP III criteria. Flow-mediated endothelium-dependent dilatation (FMD) in the brachial artery during reactive hyperemia was examined by high-resolution ultrasound technique. This study found that elevated RLP-C levels were a significant and independent risk factor for impaired FMD and angiographically proven CAD. Kaplan-Meier analysis demonstrated that higher RLP-C levels resulted in a higher probability of ischemic stroke (P=0.02 by log-rank test). A multivariate Cox hazard analysis showed that high RLP-C levels were a significant predictor of a future ischemic stroke that was independent of components of the metabolic syndrome and other traditional atherosclerotic risk factors (odds ratio 3.2, 95% CI 1.2-8.1, P<0.01). Furthermore, high RLP-C levels were a significant risk of echolucent carotid plaques, assessed by carotid ultrasound with the integrated backscatter (IBS) analysis (intima-media IBS value minus adventitia IBS【less than or equal】-16 dB) that was independent of components of metabolic syndrome and other traditional atherosclerotic risk factors (odds ratio 4.3, 95% CI 1.6-6.7, P<0.01). Treatment with bezafibrate (n=20) or atorvastatin (n=20) for 4 weeks significantly reduced RLP-C levels, with a concomitant improvement in FMD. Thus, elevated levels of RLP-C are a risk factor for CAD, endothelial vasomotor dysfunction, a predictor of coronary events, and stroke in metabolic syndrome. Measurement of RLP-C is useful for assessment of risk of cardiovascular diseases and therapeutic effects in metabolic syndrome.