Clinical Value Of HDL Particle And Accordance Of HDL-C And ApoA-? In Coronary Artery Disease

BackgroundCoronary atherosclerotic heart disease is a coronary heart disease caused by coronary atherosclerotic lesion,resulting in stenosis,or obstruction of the vascular lumen,resulting in myocardial ischemia hypoxia or necrosis.It is often called coronary artery disease(CAD).The pathophysiological basis of CAD is atherosclerosis(AS),and dyslipidemia is the main risk factor of AS.A large number of epidemiological and clinical evidence has established a posit:ive correlation between high levels of low density lipoprotein-cholesterol(LDL-C)and CAD.The domestic and foreign dyslipidemia guidelines have pointed that reducing the LDL-C levels is the target.Multiple clinical trials have proven that statin therapy significantly reduces LDL-C levels and the occurrence of cardiovascular events so that statin is widely used in clinical practice.Although enough statins decrease the LDL-C levels below currently recommended levels,residual vascular risk is still quite high.Low high density lipoprotein-cholesterol(HDL-C)level is an important factor.The Framingham Heart Study demonstrated that the risk of CAD was lower among person with higher levels of HDL-C,supporting the inverse correlation between HDL-C and CAD.As a result,there has been increasing interest in HDL-C as a therapeutic target.Despite HDL-gene mutation or the development of effective HDL-raising drugs,large-scale clinical trials showed disappointing results without expected cardiovascular benefits.While it's exciting that the REVEL study showed a positive result in cardiovascular benefits brought by a new inhibition of cholesteryl ester transfer protein(CETP)by anacetrapib may increases HDL-C levels.In a word,there are still controversies over whether increasing HDL-C levels can reduce the risk of CAD.Challenges are full of the road to therapy targeting increasing HDL-C,more focus is paid on HDL functions rather than HDL-C level.HDL is a multifunctional protein complex,ApoA-? is the major HDL apolipoprotein,accounting for almost 70%of total protein content.The most important HDL function is reverse cholesterol transportation(RCT).HDL particle is closely related to HDL functions.HDL-C/apoA-? ratio is a useful biomarker of the HDL particle to predict cardiovascular risk.Studies showed that higher large HDL particle concentration is associated with lower CAD risk,and it exists a inverse relationship between the small HDL particle concentration and CAD risk,but some studies comes to the opposite resulting from a stronger RCT of the small HDL particle.It remains uncertain how HDL particle impacts the risk of cardiovascular events.The CARDIA study published in the Journal of the American College of Cardiology(JACC)recently found that apoB was an important predictor of coronary artery calcification when apoB and LDL-C were discordant,in which apoB and LDL-C were divided into low and high group according to the 50 percentile,then pairwise combination was done into four groups.Without any supporting evidence about the accordance of HDL-C and apoA-? and CAD risk.We were inspired by the CARDIA study,and released that discordance of HDL-C and apoA-? often happens in clinical practice.When HDL-C and apoA-? are discordant,it is unknown which is better in predicting CAD risk.ObjectivesThe aim of this study is to analyze the relationship between the level of HDL-C,HDL particle,the accordance of HDL-C and apoA-I and CAD risk,the degree of coronary stenosis else.Then investigate the clinical value of HDL particle and the level of HDL-C in predicting CAD.And explore the relationship between.the accordance of HDL-C and apoA-? and CAD risk and the coronary severity.When HDL-C and apoA-? are concordant or discordant,then compare the clinical value of HDL-C with apoA-? in the risk of CAD furtherly.Methods591 patients first hospitalized in NanFang hospital were collected for coronary angiography,and calculated Gensini score respectively.HDL particle and the level of HDL-C;apoA-? were analyzed in CAD group and non-CAD group,Stable Angina Pectoris(SAP)group and Acute Coronary Syndrome(ACS)group and four groups(A,B,C,D)divided by quartile of Gensini score.And compared the value of the level of HDL-C,HDL particle in predicting CAD by receiver operating characteristic curve(ROC)analysis.Then investigated the relationship between the accordance of HDL-C and apoA-? and the severity of CAD,in which HDL-C,apoA-? were divided into low and high group according to the 50 percentile,then pairwise combination was done into four groups.ResultsCompared with non-CAD group,the level of HDL-C and HDL particle were significantly reduced in CAD group(P<0.05);Compared with SAP group,the level of HDL-C and HDL particle were also significantly reduced in CAD group(P<0.05).HDL particle,the level of HDL-C were decreased gradually in A,B,C,D group(P<0.05).Using ROC analysis,the area under curve(AUC)of HDL particle was higher than that of HDL-C.The accordance of HDL-C and apoA-? was related to the CAD risk and the severity of coronary stenosis;When HDL-C and apoA-? were concordant,compared with high HDL-C high apoA-? group,CAD risk and the severity of coronary stenosis were increased in low HDL-C low apoA-? group.When HDL-C and apoA-? were discordant,compared with high HDL-C low apoA-? group,CAD risk and the severity of coronary stenosis increased in low HDL-C high apoA-? group.Conclusion1.The lower HDL-C level and the smaller HDL particle,the higher CAD risk.2.HDL-C level,HDL particle decrease along with the aggravation in the severity of coronary stenosis,and they are inversely correlated with the severity of CAD.3.The value of HDL particle in predicting CAD risk may be superior to that of HDL-C.4.The accordance of HDL-C and apoA-? is related to the CAD risk and the severity of coronary stenosis.When HDL-C and apoA-? are concordant,compared with high HDL-C high apoA-? group,the risk of CAD and the severity of coronary stenosis increase in low HDL-C low apoA-? group.When HDL-C and apoA-?concentration are discordant,the risk of CAD and the severity of coronary stenosis increase in low HDL-C group.It shows that HDL-C may play more in predicting in CAD risk and the severity of coronary stenosis than apoA-?,when HDL-C is not in accordance with apoA-?.