מתוך medicontext.co.il
WESTPORT, CT (Reuters Health) – Large low-density lipoprotein (LDL) particle size is an independent predictor of recurrent coronary events in survivors of myocardial infarction, but treatment with pravastatin largely eliminates the risk.
A US team led by Dr. Hannia Campos of Harvard School of Public Health in Boston reports the finding in the September 26th issue of The Journal of the American Medical Association.
The team used a prospective nested-case control design to determine the relation between LDL size and recurrent coronary events in MI survivors who participated in the Cholesterol and Recurrent Events (CARE) trial, a randomized placebo-controlled trial of pravastatin conducted between 1989 and 1996.
A total of 416 case patients who experienced a recurrent coronary event and 421 control patients who did not were included in the nested study. All of these subjects had lipid concentrations typical of patients with coronary disease, the authors note.
On both univariate and multivariate analyses, a robust association between LDL particle size and recurrent coronary events emerged. After adjustment for age only, placebo-treated patients who fell in the largest quintile of LDL size (mean 26.6 nm) had a relative risk of recurrent coronary events of 1.79 compared with placebo-treated patients in the lowest quintile (mean 24.5 nm).
In a model adjusting for age as well as lipid and nonlipid risk factors, placebo-treated patients in the largest quintile of LDL size had a relative risk of 4.0.
"Large LDL size did not predict coronary events in the pravastatin group," according to Dr. Campos and colleagues. This may be because pravastatin has been shown to reduce the concentration of larger LDL particles as well as to lower the cholesterol ester content of LDL, they note.
These findings, the authors say, are "contrary to the prevailing view that a predominance of small LDL predicts coronary disease events."
They acknowledge that it probably would not be clinically useful to identify patients on the basis of LDL size, "since effective treatment for elevated LDL cholesterol concentrations also effectively treats risk associated with large LDL."
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