Dose-Response Relationships of Serum Lipid Measurements With the Extent of Coronary Stenosis

Abstract

Abstract Serum lipids, lipoproteins, and more recently apolipoproteins and lipoprotein(a) [Lp(a)] have been shown to be independent risk factors for coronary vessel disease and its prognosis. However, the relationships between serum lipid levels and the extent of coronary artery disease (CAD) have not been consistently shown. Twenty-five hundred male and female patients with suspected angina pectoris were recruited from 18 European medical centers. The independent relations of total cholesterol, triglycerides, HDL cholesterol, LDL cholesterol, apo A-I and B, and Lp(a) with the presence and extent of CAD, as assessed by coronary angiography, were investigated. All of the lipid measures showed strong relations ( P <.0001) with the presence of CAD, defined by the existence of at least one ≥50% coronary vessel stenosis. Total cholesterol, LDL cholesterol, apo B, triglycerides, and Lp(a) were substantially higher and HDL cholesterol and apo A-I lower in patients with CAD. The odds ratio of CAD, in the high-risk tertile of each lipid’s distribution compared with the low-risk tertile, was in the range 1.5 to 2.3. Each of total cholesterol (or LDL cholesterol or apo B), HDL cholesterol (or apo A), and Lp(a) had an independent effect in predicting the presence of CAD. In addition, all lipids showed a strong association ( P =.0006 for triglycerides, P <.0001 otherwise) with the extent of CAD as defined by the number of stenosed coronary vessels. These relations, which conform to a “dose-response” effect, remained after adjusting for other coronary risk factors. This study provides direct evidence of the role of serum lipid levels in determining not only the presence but also the extent of atherosclerotic disease in coronary arteries.