Elevated Small Dense Low-density Lipoprotein Cholesterol Concentration As a Promising Risk Marker for Severe Stable Coronary Heart Disease, Independently of Adiponectin and C-reactive Protein

Recent evidence suggests that decreased levels of adiponectin and elevated levels of C-reactive protein (CRP) and small, dense low-density lipoprotein cholesterol (sd-LDL-C) may be risk factors for the development of coronary heart disease (CHD) . This study sought to determine how these factors are associated with coronary events compared with LDL-C, an established potent risk factor, in stable CHD. LDL particle size, sd-LDL-C (assessed by the heparin-magnesium precipitation method), CRP, highmolecular weight adiponectin, apolipoproteins and hemoglobin A1c were compared among 219 stable CHD patients who had undergone coronary arteriography and 159 hypertensive patients without diabetes or CHD. None of the subjects received lipid-lowering drugs during the study. A coronary event was defined as a revascularization procedure within 6 months of blood measurement. Fasting LDL-C, sd-LDL-C, apolipoprotein B, hemoglobin A1c, and CRP were significantly higher in the patients with coronary events than in those without events. High-density lipoprotein cholesterol, apolipoprotein A-1 and adiponectin were significantly lower in the patients with coronary events than in those without events. LDL-C levels were similar between the non-CUD hypertensives and the CHD patients with events. Elevated sd-LDL-C was the only parameter found to be significantly associated with severe CHD independent of LDL-C, high-densty lipoprotein cholesterol, apolipoprotein B, adiponectin and CRP by multiple logistic regression analysis. These results suggest that sd-LDL-C is superior to LDL-C and adiponectin for predicting the progression of stable CHD.