Predictors of Cardiovascular Disease in Dysbetalipoproteinemia

Hypertension, smoking, and the levels of triglycerides were found to be independently associated with the risk for cardiovascular disease in patients with dysbetalipoproteinemia, according to study results published in the Journal of Clinical Lipidology.

The risk for cardiovascular conditions such as coronary artery disease and peripheral artery disease is higher in patients with dysbetalipoproteinemia, however, little is known about the cardiovascular risk factors in this population. The objective of this study was to describe the clinical characteristics of a large cohort with dysbetalipoproteinemia and to identify predictors of cardiovascular conditions in this population.

In this study, researchers examined the data of 17,109 patients from a lipid clinic research database in Montreal, Quebec, Canada. A total of 221 patients in this database had dysbetalipoproteinemia. Inclusion criteria for the study were: age ≥18 years, apoE2/E2, triglycerides >135 mg/dL (1.5 mmol/L), and a ratio of very low density lipoproteins (VLDL-C) to plasma triglycerides >0.30). Baseline clinical data were collected between 1969 and 2004, and blood samples were obtained from each patient after a 12-hour overnight fast at baseline. The study’s main outcome was the presence of prevalent cardiovascular disease (eg, angina, myocardial infarction, peripheral angioplasty, and stroke). 

Of the 221 patients included in this study, 51 participants (23%) had a history of cardiovascular disease. Three factors were found to be independent predictors of cardiovascular disease: hypertension (odds ratio [OR], 5.68; 95% CI, 2.13-15.16; P =.001), pack year of smoking (OR, 1.03, 95% CI, 1.01-1.05, P =.01) and triglycerides tertile (OR, 1.82, 95% CI, 1.09-3.05, P =.02). The prevalence of cardiovascular disease was 51% in patients with hypertension vs 18% in those without hypertension (P =.00001), and 30%, 24%, and 15% in patients in the highest, second, and lowest triglycerides tertiles, respectively (P =.04). Heavy smokers had the highest prevalence of cardiovascular disease, compared with mild smokers and nonsmokers (36%, 27%, and 13%, respectively; P =.006).

Study limitations include the retrospective reporting of cardiovascular events, and the exclusion of patients with another mutation for dysbetalipoproteinemia.

“Treatment that focus on lifestyle changes should be initiated in all patients [with dysbetalipoproteinemia], but more aggressive treatment should be initiated in those at higher [cardiovascular] risk,” concluded the study authors. “In particular, smoking cessation and adequate blood pressure control beside hypolipidemic drugs are of major importance for these patients.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Paquette M, Bernard S, Paré G, Baass A. Triglycerides, hypertension, and smoking predict cardiovascular disease in dysbetalipoproteinemia [published online December 24, 2019]. J Clin Lipidol. doi: 10.1016/j.jacl.2019.12.006