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Fractional Esterification Rate of Cholesterol and Ratio of Triglycerides to HDL-Cholesterol Are Powerful Predictors of Positive Findings on Coronary Angiography

Jiri Frohlich^1,a and Milada Dobiáová²

¹ Department of Pathology and Laboratory Medicine, University of British Columbia, Healthy Heart Program/Lipid Clinic, St. Paul’s Hospital, Vancouver, BC V6Z 1Y6, Canada.

² Institute of Physiology, Academy of Sciences of the Czech Republic, Prague, Czech Republic 14220.

^aAddress correspondence to this author at: Healthy Heart Program, St. Paul’s Hospital, B180-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada. Fax 604-806-8590/3; e-mail jifr{at}interchange.ubc.ca.

Background: We examined the predictive value of various clinical and biochemical markers for angiographically defined coronary artery disease (aCAD). Specifically, we assessed the value of the ratio of plasma triglyceride (TGs) to HDL-cholesterol (HDL-C) and the fractional esterification rate of cholesterol in plasma depleted of apolipoprotein B (apoB)-containing lipoproteins (FER_HDL), a functional marker of HDL and LDL particle size.

Methods: Patients (788 men and 320 women) undergoing coronary angiography were classified into groups with positive [aCAD(+)] and negative [aCAD(-)] findings. Patient age, body mass index, waist circumference, blood pressure (BP), medications, drinking, smoking, exercise habits, and plasma total cholesterol (TC), LDL-cholesterol (LDL-C), HDL-unesterified cholesterol, HDL-C, TGs, FER_HDL, apoB, log(TG/HDL-C), and TC/HDL-C were assessed. Lipids and apoproteins were measured by standard laboratory procedures; FER_HDL was determined by a radioassay.

Results: Members of the aCAD(+) group were older and had a higher incidence of smoking and diabetes than those in the aCAD(-) group. The aCAD(+) group also had higher TG, apoB, FER_HDL, and log(TG/HDL-C) and lower HDL-C values. aCAD(+) women had greater waist circumference and higher plasma TC and TC/HDL-C. aCAD(+) men, but not women, had higher plasma LDL-C. In the multivariate logistic model, the significant predictors of the presence of aCAD(+) were FER_HDL, age, smoking, and diabetes. If only laboratory tests were included in the multivariate logistic model, FER_HDL appeared as the sole predictor of aCAD(+). Log(TG/HDL-C) was an independent predictor when FER_HDL was omitted from multivariate analysis.

Conclusions: FER_HDL was the best laboratory predictor of the presence of coronary atherosclerotic lesions.

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