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. 2019 Jul;70(1):98-107.
doi: 10.1002/hep.30518. Epub 2019 Mar 29.

Small Dense Low-Density Lipoprotein Cholesterol Predicts Cardiovascular Events in Liver Transplant Recipients

Mohammad Bilal Siddiqui  1 , Tamoore Arshad  2 , Samarth Patel  1 , Emily Lee  1 , Somaya Albhaisi  3 , Arun J Sanyal  1 , R Todd Stravitz  1 , Carolyn Driscoll  1 , Richard K Sterling  1 , Trevor Reichman  4 , Chandra Bhati  4 , Mohammad Shadab Siddiqui  1
Affiliations

Small Dense Low-Density Lipoprotein Cholesterol Predicts Cardiovascular Events in Liver Transplant Recipients

Mohammad Bilal Siddiqui et al. Hepatology. 2019 Jul.

Abstract

Cardiovascular disease (CVD) is an important cause of morbidity and mortality after liver transplantation (LT). Although LT is associated with dyslipidemia, particularly atherogenic lipoprotein subparticles, the impact of these subparticles on CVD-related events is unknown. Therefore, the aim of the current study was to evaluate the impact of small dense (sdLDL-C) low-density lipoprotein (LDL) cholesterol (LDL-C) on CVD events. Prospectively enrolled patients (N = 130) had detailed lipid profile consisting of traditional lipid parameters and sdLDL-C and were followed for CVD events. The primary endpoint was a CVD composite consisting of myocardial infarction (MI), angina, need for coronary revascularization, and cardiac death. Mean age of the cohort was 58 ± 11 years, and the most common etiology of liver disease (LD) was hepatitis C virus (N = 48) and nonalcoholic steatohepatitis (N = 23). A total of 20 CVD events were noted after median follow-up of 45 months. The baseline traditional profile was similar in patients with and without CVD events. A serum LDL-C cutoff of 100 mg/dL was unable to identify individuals at risk of a CVD event (P = 0.86). In contrast, serum concentration of atherogenic sdLDL-C >25 mg/dL was predictive of CVD events with a hazard ratio of 6.376 (95% confidence interval, 2.65, 15.34; P < 0.001). This relationship was independent of diabetes, hypertension, sex, ethnicity, LD, obesity, and statin use. Conclusion: sdLDL-C independently predicted CVD events whereas LDL-C did not. Thus, sdLDL-C may provide a useful clinical tool in risk stratifying and managing patients after LT.

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Conflict of interest statement

Potential conflict of interest: Dr. Sterling received grants from AbbVie, Roche, and Gilead. Dr. Sanyal consults for and received grants from Echosens-Sandhill, Gilead, malinckrodt, Salix, Novartis, Galectin, and Sequana. He consults for and is employed by Sanyal Bio. He consults for and owns stock in Genfit. He consults for Pfizer, Nitto Denko, Nimbus, Boehringer Ingelheim, Hemoshear, Lilly, and Ardelyx. He received grants from Conatus, Bristol-Myers Squibb, and Merck. He received royalties from Elsevier and Uptodate. He owns stock in Akarna, NewCo LLC, Tiziana, and Natural Shield.

Figures

FIG. 1.
FIG. 1.
(A) Total serum cholesterol. (B) LDL-C. (C) HDL-C. (D) Serum triglycerides.
FIG. 2.
FIG. 2.
(A) apoA-1. (B) HDL-2. (C) sdLDL-C. (D) LDL particle size. (E) VLDL-P. (F) VLDL particle size.
FIG. 3.
FIG. 3.
Kaplan-Meier plot showing cumulative probability of remaining free CVEs according to (A) LDL-C and (B) sdLDL-C.
See this image and copyright information in PMC

Comment in

References

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