In 69
statin-treated male coronary patients with
low-density lipoprotein cholesterol at goal levels (<70 mg/dl), the investigators tested whether low
high-density lipoprotein (
HDL) cholesterol (<40 mg/dl) and high
triglyceride (>150 mg/dl) are associated with dysfunctional HDL particles and abnormal
insulin,
adiponectin,
C-reactive protein serum levels. Thirty-four patients with low
HDL cholesterol and high
triglyceride (
dyslipidemia) and 35 patients with
low-density lipoprotein cholesterol,
HDL cholesterol, and
triglyceride at target levels (normolipidemia) were studied. Twenty healthy men were also studied.
High-sensitivity C-reactive protein was measured using immunonephelometry,
insulin using a radioimmunometric assay, and total
adiponectin by
enzyme-linked
immunosorbent assay. Cell
cholesterol efflux to serum and total isolated HDL was assayed using rat
hepatoma Fu5AH cells for
scavenger receptor class B type 1-mediated efflux. Compared to the normolipidemia and healthy groups, and after adjustment for age and waist circumference, patients with
dyslipidemia showed higher fasting
insulin (14, 9.9, and 8.5 μU/ml, respectively), homeostasis model assessment of
insulin resistance values (3.4, 2.3, and 1.8, respectively), lower
adiponectin concentrations (5.1, 8.1, and 11 μg/ml, respectively), and reduced
cholesterol efflux to serum (14%, 15%, and 19%, respectively) and to HDL fractions (4.4%, 4.6%, and 5.6%, respectively) (p <0.05 for all variables). Multivariate analysis showed that
adiponectin and
apolipoprotein A1 accounted for 10.7% and 3.9%, respectively, of the variance in
cholesterol efflux. In conclusion, the decreased
cholesterol efflux and metabolic abnormalities found in the
dyslipidemia group may contribute to the residual risk observed in the large
statin trials and the higher morbidity and mortality in
statin-treated coronary patients with low
HDL cholesterol even when attaining
low-density lipoprotein cholesterol <70 mg/dl.