Prevalence of cardiovascular risk factors in coronary heart disease patients with different low-density lipoprotein phenotypes]

Low-density lipoprotein (LDL) heterogeneity is now well recognized as an important factor reflecting differences in lipoprotein composition, size, metabolism and genetic influences. There is an abundant evidence of data supporting the clinical importance of small, dense LDL particles in the development of coronary heart disease. The aim of the study was to determine the prevalence of LDL phenotypes A and B in coronary artery disease patients and to assess the incidence of cardiovascular risk factors in groups with different phenotype.Demographic, anamnestic and clinical data as well as complete lipid profile--total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein (HDL) cholesterol and triglycerides--were collected on 1,220 patients (63.7% male and 36.3% female, mean age 61.3+/-11.0 years) with coronary artery disease. Triglycerides/HDL cholesterol ratio was calculated. By value of triglycerides/HDL cholesterol ratio, proposed V. Hanak and authors, the patients were identified as having LDL phenotype A when the ratio was < or =1.64 (a value of 3.8 as expressed in milligrams per deciliter) and phenotype B when the ratio was >1.64.LDL profile in 60.5% of patients was identified as phenotype A and in 39.5%--as phenotype B. The incidence of coronary heart disease risk factors was higher in phenotype B patients as compared to phenotype A subjects (hypertension - 85.1% vs. 75.2%, p<0.001, diabetes mellitus--13.9% vs. 5.5%, p<0.001, obesity--46.7% vs. 28.0%, p<0.001, reduced physical activity--64.5% vs. 57.0%, p<0.001). Metabolic syndrome was present in 85.1% of phenotype B patients, while this cluster of metabolic disorders was detected only in 36.8% of phenotype A subjects. The incidence of myocardial infarction, presence of multiple high-grade coronary lesions were also higher in phenotype B patients as compared to their counterparts with phenotype A (22.2% vs. 17.2%, p<0.05 and 13.7% vs. 8.7%, p<0.05).LDL phenotype B was determined in 39.5% of coronary heart disease patients. Atherogenic LDL subclass pattern B correlated with higher incidence of major coronary heart disease risk factors.