Academic journal article Iranian Journal of Public Health

Lipid Variables Related to the Extent and Severity of Coronary Artery Disease in Non-Diabetic Turkish Cypriots

Academic journal article Iranian Journal of Public Health

Lipid Variables Related to the Extent and Severity of Coronary Artery Disease in Non-Diabetic Turkish Cypriots

Article excerpt


Because of the significant reduction that has been documented in the progression of atherosclerosis and cardiovascular events through the treatment of dyslipidemia by statins, the non-invasive documentation of atherosclerotic lesions has become an increasingly important target for early treatment and preventive measures (1-3). Techniques such as density gradient ultracentrifugation, non-denaturing gradient gel electrophoresis, and nuclear magnetic resonance spectroscopy are available to measure lipid particles to predict the risk of coronary artery disease (CAD); however, these techniques are labor-intensive, technically demanding, expensive, and slow to produce results (4-6). Thus, although these techniques are precise and accurate, they are not widely used in clinical settings, and developing surrogate markers of lipid particle profiles is of considerable clinical and economic importance (3). The association between the serum levels of total cholesterol and low-density lipoprotein cholesterol (LDL-c) in the development of CAD has been well established, whereas low serum levels of HDL-c have been considered a major risk factor for CHD (7).

Lipid particle subfractions play an important role in the atherogenic process. Small, dense LDL particles are more atherogenic than larger particles. Larger, less dense HDL2 particles are considered protective, whereas the smaller, denser HDL3 particles are considered atherogenic (8, 9). The former particles correlate inversely with serum TG levels and small, dense LDL levels (10).

The TG/HDL-C ratio, which is a relatively novel lipoprotein index indicating the presence of small, dense LDL particles, serves as a potentially significant predictor of CAD (11, 12). Moreover, it was shown to be one of the non-invasive parameters that are most strongly associated with the extent of coronary disease, as assessed by the Friesinger index from conventional coronary angiography (13).

To the best of our knowledge, despite the growing number of patients diagnosed with CAD, no study has reported an association between the lipid parameters, particularly the TG/HDL-C ratio, and extensive CAD in Mediterranean populations, particularly in Cypriots. Therefore, the present study was designed to investigate the association between lipid variables, particularly the TG/HDL-C ratio, and the extent and severity of CAD in Turkish Cypriots with suspected CAD.

Materials and Methods

Study population

A total of 412 consecutive non-diabetic patients with suspected CAD (mean (SD) age: 58.8 (10.5) years, 50.1% male) who admitted to the hospital between January 2009 and January 2012 who underwent diagnostic coronary angiography upon referral to our cardiovascular laboratory were included in this single-center, cross-sectional study. Non-diabetic patients aged 18-70 years were included in the study, whereas we excluded patients with co-morbid chronic diseases, concomitant medications affecting carbohydrate metabolism, pregnant patients and Turkish patients who were born outside Cyprus.

Cyprus is the third largest island in the Mediterranean Sea. There are two major ethnic groups in the island, namely the Turkish Cypriots who speak Turkish and are Muslims and the Greek Cypriots who speak Greek and are mostly Orthodox Christians. In addition, other ethnic groups include Maronites, Armenians and Latins. Study population included non-diabetic Turkish Cypriots living in North Cyprus since 1974.

Written informed consent was obtained from each subject following a detailed explanation of the objectives and protocol of the study, which was conducted in accordance with the ethical principles stated in the "Declaration of Helsinki"; this study was approved by the institutional ethics committee.

Study parameters

The clinical variables included patient demographics (age, gender), traditional risk factors for atherosclerosis (such as hypertension, diabetes, smoking, hyperlipidemia, and positive family history) and the blood biochemistry of the lipid parameters, including total cholesterol, LDL-c, HDL-c, triglycerides and the TG/HDL-c ratio; these variables were categorized into quartiles. …

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