Antiatherogenic effect of HDL subpopulations in patients with newly diagnosed peripheral artery disease

Czech version

Authors: M. Kaško ¹; P. Gavornik ¹; K. Gruber ²; S. Oravec ¹; A. Dukát ¹
Authors‘ workplace: II. interná klinika Lekárskej fakulty UK a UN Bratislava, Slovenská republika, prednosta doc. MUDr. Ľudovít Gašpar, CSc. ¹; Interná klinika Landeskrankenhaus, Thermenregion Baden, Viedeň, Rakúsko, prednosta Univ. Doc. Dr. Med. Johann Pidlich ²
Published in: Vnitř Lék 2012; 58(7 a 8): 37-41
Category: 80th Birthday MUDr. Miroslav Mydlík, DrSc.

Overview

Objective:
To assess the relationship of high-density lipoprotein subfractions to newly diagnosed lower extremity artery disease (LEAD) in individuals without diabetes mellitus (DM).

Background:
The high-density lipoprotein (HDL) family forms a protective part of plasma lipoproteins. It consists of large HDL, intermediate HDL, and small HDL subclasses. The large HDL and intermediate HDL subclasses are widely considered as anti-atherogenic parts of the HDL family. The atherogenicity of the small HDL subclass is currently the subject of wide interest. The association of HDL cholesterol (HDL-C) spectrum abnormality with lower extremity artery disease has not been investigated yet. In the patients with this vascular impairment (LEAD) were identified the HDL subclasses. Patients with peripheral artery disease – lower extremity artery disease as a consequence of atherosclerosis may be often affected by lower extremity pain, worsen ambulation and in addition mutilating wounds. In addition patients with LEAD are affected by normal-to-high HDL atherogenic dyslipidemia. Thus, there is significantly higher risk of cardiovascular morbidity and mortality.

Methods:
This clinical study involving 96 subjects: 48 were newly diagnosed LEAD patients (29 men of average age 56 ± 9, 19 women of average age 61 ± 7) and no DM anamnesis and were not on hypolipidemic therapy; another 48 subjects – control group (24 men of average age 56 ± 12, 24 women of average age 57 ± 13) were without clinical presentation of LEAD and were normolipidemic. Quantitative and qualitative analysis of HDL subclasses were performed by an innovative electrophoresis method on polyacrylamide gel (PAGE), the Lipoprint HDL system, Quantimetrix.

Results:
In LEAD patients, HDL-C levels as well as intermediate HDL subfraction levels were significantly decreased (p < 0.0001 and p < 0.03 respectively). The small HDL particles subfraction was significantly higher (p < 0.01).

Conclusion:
These findings pointed out that the reduction of HDL-C and intermediate HDL subpopulation and even the increase of small HDL subclass may be considered as important predictors of cardiovascular events in newly diagnosed LEAD. There are undisputable advantages of using Lipoprint HDL to identificate HDL subfractions. The presence of a high concentration of small HDL particles in patients with LEAD emphasize that the atherogenic subclass of HDL family is comparable with small HDL.

Keywords:
cardiovascular diseases – peripheral artery disease – lower extremity artery disease – HDL cholesterol – small HDL particles – pro-atherogenic effect of small high-density lipoprotein particles

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