Is There Potential Clinical Benefit of Lowering Triglycerides Through LPL Pathway?

Despite very different effects on plasma lipid levels, triglyceride lowering lipoprotein lipase (LPL) variants and LDL-C lowering low-density lipoprotein receptor (LDLR) variants had the same effect on the risk of coronary heart disease per unit change in apoB, according to new research presented Aug. 28 at ESC Congress 2018. This suggests that that all apoB100-containing lipoproteins have the same effect on the risk of coronary heart disease, researchers said.

The study by Brian A. Ference, MD, MPhil, MSc, FACC, et al., involved 654,783 participants from 63 cohort or case-control studies conducted in North America or Europe between 1948 and 2017. Researchers evaluated the association of LPL and LDLR genetic scores, respectively, with changes in plasma lipid and lipoprotein levels and the risk of cardiovascular events.

Results showed that for each 10 mg/dL lower apoB, the LPL score was associated with 69.8 mg/dl lower plasma triglycerides and 0.7 mg/dl higher plasma LDL-C; while the LDLR score was associated with 14.2 mg/dl lower plasma LDL-C and 1.9 mg/dl lower plasma triglycerides. However, researchers noted that despite the significant differences in the associated changes in plasma lipid levels for the same change in plasma apoB-containing lipoprotein level, the LPL and LDLRscores were associated with a nearly identical 23 percent lower risk of coronary heart disease per 10 mg/dl lower apoB. Additionally, the associations of the LPL and LDLR scores with plasma lipids, lipoprotein levels and the risk of coronary heart disease appeared to be independent and additive.

"Lowering triglycerides or LDL-C appears to have the same effect on the risk of coronary heart disease per apoB particle lowered," researchers said. "Therefore, the clinical benefit of any lipid lowering therapy should be proportional to the absolute change in apoB levels, regardless of the change in plasma triglyceride or LDL-C levels."

Keywords: ESC18, ESC Congress, Angina, Stable, Triglycerides, Lipoproteins, Coronary Disease

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