| Effects of apolipoprotein and low density lipoprotein receptor gene polymorphisms on lipid metabolism, and the lipid risk factors of coronary artery disease | ||
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The plasma total cholesterol, LDL and HDL cholesterol values and the plasma triglyceride values of patients with coronary artery disease were similar to those of other CAD populations (Kauppinen-Mäkelin & Nikkilä 1988, Nieminen et al. 1992).The lipid profile of the coronary patients was more atherogenic than that of the controls, and the patients with > 50% stenosis had an even more atherogenic lipid profile than those with < 50% stenosis. The decline in HDL cholesterol with the severity of CAD was typical of men and the increase in plasma triglycerides of women. It has been postulated that a high plasma triglyceride concentration together with small dense LDL particles is associated with premature CAD (Coresh et al. 1993, Ballantyne 1998), the atherogenic LDL particles originating from VLDL (Teng et al. 1986). An increase in total triglycerides, a decrease in HDL cholesterol (Höstmark et al. 1990) and an association of elevated total and LDL cholesterol and total triglycerides and low HDL cholesterol (Bolibar et al. 1995) with the increasing extension of CAD have been reported, and a lowering of VLDL cholesterol and triglycerides has been reported to associate with a slowing down of the progression of coronary arteriosclerosis in young AMI survivors (Ericsson et al. 1996).
The male patients with two- and three-vessel stenosis also had higher VLDL cholesterol and VLDL triglycerides than the controls, but the differences were not so clear as in females, and the correlation with the increasing severity of CAD was weaker than in women. The differences in the HDL cholesterol values between the male patients with one-, two- or three-vessel disease were not statistically significant, although there was a trend towards lower HDL cholesterol concentrations in the patients with three-vessel disease compared with one- or two-vessel disease. VLDL cholesterol and triglyceride concentrations have been reported to discriminate male AMI survivors from controls, and LDL cholesterol has been claimed to be the best discriminator of AMI patients with different extensions of coronary atheromatosis, but not of coronary stenosis (Hamsten et al. 1986)
VLDL triglycerides and cholesterol were the only lipids discriminating the female controls from the patients with three-vessel stenosis without any overlap. All the diabetic female patients had two- or three-vessel disease, as did seven of the nine hypertensive women. It seems that women with two- or three-vessel stenosis often have multiple risk factors combined to a special lipid profile with high VLDL lipids and low HDL cholesterol, whereas their LDL and total cholesterol values are comparable to those of other CAD patients. This finding is in accordance with the results reported by Johansson and co-workers on female AMI survivors (Johansson et al. 1988). The association of VLDL lipids with the severity of CAD in women appears strong, but as this is a cross-sectional study, no causal relationship can be established on the basis of the present results.