LDL-c belangrijkste lipidendeterminant van atherosclerose

Low-density lipoprotein (LDL) cholesterol appears to be the main lipid driver of atherosclerosis, show findings from the Multiethnic Study of Atherosclerosis (MESA).
 

Participants with forms of dyslipidemia that included elevated LDL cholesterol had increased carotid intima-media thickness (CIMT) and coronary artery calcium (CAC) relative to those with other lipid abnormalities or normolipidemia.
 

Pathmaja Paramsothy (University of Washington, Seattle, USA) and colleagues note that their results are widely generalizable, due to the multiethnic make-up of the study population."Greater efforts are needed to detect dyslipidemia in primary prevention and consider appropriate treatment," they write in the Journal of the American College of Cardiology.

The team grouped 4792 MESA participants who were not using lipid-lowering or antidiabetic drugs according to their lipid profiles, using cut points of 160 and 150 mg/dl (4.1 and 1.7 mmol/l) to denote elevated LDL cholesterol and triglycerides, respectively, and cut points of 40 and 50 mg/dl (1.0 and 1.3 mmol/l) to denote reduced high-density lipoprotein (HDL) cholesterol in men and women, respectively.Participants with simple hypercholesterolemia (high LDL cholesterol) and also those with combined hyperlipidemia (high LDL cholesterol and triglycerides) had an average CIMT that was 0.048 mm greater than in participants with normolipidemia.Both of these dyslipidemic groups were a significant 22% more likely to have CAC than were participants with healthy lipid profiles.Participants with metabolic syndrome dyslipidemia (low HDL cholesterol and high triglycerides) were a significant 9% more likely to have CAC relative to normolipidemic participants, but their average CIMT was not increased.
 

CIMT in participants with low HDL cholesterol was a significant 0.021 mm greater than in normolipidemic participants, but the likelihood of having CAC was similar for both groups. Having hypertriglyceridemia did not influence participants' CIMT or likelihood of having CAC.
 

"The MESA study investigators provide reassuring evidence that LDL cholesterol is the dominant lipid determinant of vascular damage," said editorialists GB John Mancini (Vancouver Hospital, British Columbia, Canada) and Jiri Frohlich (University of British Columbia, Vancouver).
 

"This rich database will provide further insights into controversial issues of vascular health pertaining, for example, to the interplay between dyslipidemia and factors such as sex, ethnicity, high sensitivity C-reactive protein, and metabolic syndrome."