Small Dense Low‐Density Lipoprotein Cholesterol Predicts Cardiovascular Events In Liver Transplant Recipients

Abstract

Introduction

Cardiovascular disease is an important cause of morbidity and mortality after liver transplantation (LT). Although LT is associated with dyslipidemia, particularly atherogenic lipoprotein sub‐particles, the impact of these sub‐particles on cardiovascular disease (CVD) related events is unknown. Therefore, the aim of the current study was to evaluate the impact of small dense low‐density lipoprotein cholesterol (sdLDL‐C) on CVD events.

Methods

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, angina, need for coronary revascularization, and cardiac death.

Results

The mean age of the cohort was 58±11 years and the most common etiology of liver disease was hepatitis C (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 small dense LDL‐C > 25mg/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, gender, ethnicity, liver disease, obesity and statin use.

Conclusion

Small dense LDL‐C independently predicted CVD events while 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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