Modifiable risk factors such as elevated cholesterol, coupled with other nonmodifiable risk factors such as diabetes diagnosis, are well known to represent additive risk of adverse cardiovascular outcomes. A new study published in Lipids in Health and Disease examines the role that remnant-like particle cholesterol plays in the complex cascade of coronary artery disease development and progression in menopausal women with diabetes mellitus (DM), a population group in whom few studies of this type have been conducted. 

Lead author Xunxun Feng and colleagues affiliated with the Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart Lung and Blood Vessel Disease studied nearly 4,800 women aged 50 years or older who, during 2015, had coronary angiograms performed and some of whom also had DM. The team set out to explore whether remnant-like particle cholesterol (RLP-C) contributes to the progression of coronary artery disease (CAD) in this group and whether physiological changes associated with menopause pose increased risk. 

The team divided the subjects into two groups, those with CAD and those without CAD. Of the total study population, there were 1,496 patients with diabetes, representing roughly 30% of the total subjects. This group was further divided into those with DM and CAD (n = 1,031) and those with DM, but not CAD (n = 465). 

The research team used a case-report form to collect demographic and clinical data. Data consisted of age, personal history of smoking and drinking, family history of cardiovascular disease, and personal medical history, including diabetes mellitus, hypertension, hyperlipidemia, and medication therapy. Additional data collected were body mass index and blood pressure. At baseline, fasting blood samples were taken and total cholesterol (TC) and triglyceride (TG) levels were determined, as were LDL-C and high-density lipoprotein cholesterol (HDL-C) levels. RLP-C was defined as TC-(LDL-C + HDL-C).

Using univariate and multivariate logistic regression analysis, the team reported that RLP-C was an independent risk factor for CAD in menopausal women (odds ratio [OR] 1.232, 95% CI, 1.070-1.419) and that in the group with diabetes, RLP-C was an independent risk factor for CAD (OR 1.366, 95% CI, 1.043-1.791). The authors concluded that “RLP-C was proved to be an independent risk factor for menopausal women with CAD and DM.”

The team did report limitations in the study, pointing out that it was a cross-sectional study lacking basic research as a foundation. They also noted that additional cardiovascular risk factors such as lipoprotein A or apolipoprotein B were not evaluated and that estrogen data were not available for the subjects and, therefore, a statistical analysis of estrogen in a menopausal population could not be carried out. Lastly, they noted that since the subjects were all from the same hospital in 2015, patient-selection time was limited.

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