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Small Dense Low‐Density Lipoprotein Cholesterol Predicts Cardiovascular Events in Liver Transplant Recipients
Author(s) -
Siddiqui Mohammad Bilal,
Arshad Tamoore,
Patel Samarth,
Lee Emily,
Albhaisi Somaya,
Sanyal Arun J.,
Stravitz R. Todd,
Driscoll Carolyn,
Sterling Richard K.,
Reichman Trevor,
Bhati Chandra,
Siddiqui Mohammad Shadab
Publication year - 2019
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.30518
Subject(s) - medicine , hazard ratio , dyslipidemia , myocardial infarction , cardiology , unstable angina , diabetes mellitus , liver transplantation , confidence interval , disease , transplantation , endocrinology
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.