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

在两组因心脏（n=93）或非心脏（n=26）病例突然意外死亡的日本受试者中进行了尸检血浆脂质和脂蛋白分析。两组中没有人有明显的病史或心脏病史。在这项研究中，我们测量了血浆总胆固醇，甘油三酯，极低密度脂蛋白胆固醇，低密度脂蛋白胆固醇，高密度脂蛋白胆固醇，特别是脂蛋白残余。甘油三酯和富含载脂蛋白E的残粒样颗粒（RLP）已被研究为心源性猝死的可能危险因素。血浆RLP-胆固醇（RLP-C）和RLP-甘油三酯（RLP-TG）值与冠状动脉粥样硬化的进展和心脏性猝死的风险也进行了研究。受试者工作特征曲线（ROC）分析显示，在血脂和脂蛋白中，RLP-TG是心源性猝死最显著的危险因素，RLP-C是冠状动脉粥样硬化的最大预测因子。在大多数病例中，HDL-C和LDL-C水平在正常范围内，似乎与心源性猝死无关。采用载脂蛋白E表型分析法检测脂代谢的遗传背景。与残余代谢密切相关的ApoE 3/3（野生型）表型频率在心源性猝死组中明显降低。这些结果表明，RLP-C和RLP-TG水平升高在冠状动脉粥样硬化和心源性猝死中更普遍，并且可能是这些事件的更好预测因子。

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.