LAUSR

Objective: The use of LDL-cholesterin particles (LDL-p) for cardiovascular risk prediction has been tested in high risk populations. The objective of this study was to evaluate the association of LDL-p and LDL-p composition with incident cardiovascular disease in adults participating in the Hortega Follow-up Study, a cohort study representative of a general population from Spain. Figure. No caption available. Design and method: “Standard” lipid levels (plasma total cholesterol, HDL-cholesterol, and triglyceride concentrations) were determined using a Hitachi 917 analyzer. The number and size of lipid particles were measured by nuclear magnetic resonance using LIPOSCALE algorithm (Biosfer Teslab, Reus, Spain). The association of lipid levels and LDL-particles composition with incident cardiovascular disease was assessed. Results: A total of 1162 subjects (49% male, mean age 49.7 years) was included into the study. LDL-p distribution was as followed: Small LDL-p was predominant (40–70%), followed by Medium LDL-p (20–40%) and Large LDL-p (10–20%). During a mean-follow up of 12.4 ± 3.3 years, a total of 159 CV events occurred. LDL particle size was related to all events when traditional cardiovascular risk factors were controlled for. Medium LDL-p, but not Small LDL-p, increased the risk of CHD and stroke in all statistical models. The relevance of Medium LDL-p was further evaluated in a compositional analysis using a leave-one-out approach. The highest risks were observed for LDL-p and CHD when the proportions of Medium and Small LDL-p were entered simultaneously into the model, which reflects an increase in the proportion of Medium LDL-p and Small LDL-p by a corresponding decrease in the proportion of Large LDL-p, respectively. That shift from Large to Medium and Small LDL-p proportions was associated with an increase in risk for CHD of 70% and 46%, respectively (figure 1). Conclusions: In a representative sample of the general population from Spain, NMR-measured LDL-particle size and composition were associated with cardiovascular outcomes. An increase in the proportion of Medium LDL-particles and Small LDL-particles by a corresponding decrease in the proportion of Large LDL-p was strongly associated with CHD. Further research is needed to elucidate the causal pathways underlying these associations.