Small dense LDL cholesterol in human subjects with different chronic inflammatory diseases

• Published in: Nutrition, metabolism, and cardiovascular diseases Vol. 28; no. 11; pp. 1100 - 1105
• Main Authors: Schulte, D.M., Paulsen, K., Türk, K., Brandt, B., Freitag-Wolf, S., Hagen, I., Zeuner, R., Schröder, J.O., Lieb, W., Franke, A., Nikolaus, S., Mrowietz, U., Gerdes, S., Schreiber, S., Laudes, M.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.11.2018
• Subjects: Adult; Aged; Anti-Inflammatory Agents - therapeutic use; antibodies; Atherosclerosis - blood; Atherosclerosis - diagnosis; Atherosclerosis - immunology; Biomarkers - blood; cardiovascular diseases; Case-Control Studies; Cholesterol, LDL - blood; Chronic Disease; Chronic inflammatory disease; clinical trials; drug therapy; Dyslipidemia; Female; females; Germany; Humans; Inflammation; inflammatory bowel disease; Inflammatory Bowel Diseases - blood; Inflammatory Bowel Diseases - diagnosis; Inflammatory Bowel Diseases - drug therapy; Inflammatory Bowel Diseases - immunology; lipid metabolism; longevity; low density lipoprotein cholesterol; Male; males; Middle Aged; observational studies; Particle Size; patients; Phenotype; Prospective Studies; psoriasis; Psoriasis - blood; Psoriasis - diagnosis; Psoriasis - drug therapy; Psoriasis - immunology; Receptors, Interleukin-6 - antagonists & inhibitors; Receptors, Interleukin-6 - immunology; Risk Factors; sdLDL; Spondylitis, Ankylosing - blood; Spondylitis, Ankylosing - diagnosis; Spondylitis, Ankylosing - drug therapy; Spondylitis, Ankylosing - immunology; Time Factors; Treatment Outcome; Tumor Necrosis Factor-alpha - antagonists & inhibitors; Tumor Necrosis Factor-alpha - immunology; Germany; sdLDL; Inflammation; Chronic inflammatory disease; Dyslipidemia
• ISSN: 0939-4753; 1590-3729; 1590-3729
• DOI: 10.1016/j.numecd.2018.06.022

Chronic inflammatory diseases (CID) are associated with a profound increase in cardiovascular (CV) risk resulting in reduced life expectancy. However, LDL-cholesterol is reported to be low in CID patients which is referred to as the “LDL paradoxon”. The aim of the present study was to investigate whether LDL-particles in CID exhibit an increased content of the highly atherogenic small-dense LDL subfraction (sdLDL). In this prospective, single center, observational study we enrolled 141 patients with CID (RA n = 59, inflammatory bowel disease (IBD) n = 35, ankylosing spondylitis (SpA) n = 25, Psoriasis n = 22) in 2011 through 2013 to evaluate sdLDL levels before as well as 6 and 26 weeks after initiation of different anti-cytokine therapies (anti-TNFα, anti-IL-6R antibodies). sdLDL levels were compared to 141 healthy individuals in a case control design. Compared to healthy controls, all CID patients displayed a significantly higher sdLDL content within the LDL cholesterol fraction: RA 35.0 ± 9.2% (p < 0.001), SpA 42.5 ± 10.5% (p < 0.001), IBD 37.5 ± 7.1% (p < 0.001), Psoriasis 33.6 ± 4.6% (p < 0.01). Furthermore, the sdLDL/LDL ratio was significantly higher in male compared to female RA subjects (p < 0.05). Neither anti-TNFα nor anti-IL6R medication altered sdLDL levels despite a significant improvement of disease activity. In several different chronic inflammatory disease entities, LDL-cholesterol is shifted toward a pro-atherogenic phenotype due to an increased sdLDL content which might in part explain the LDL paradoxon. Since premature CV disease is a major burden of affected patients, specifically targeting lipid metabolism should be considered routinely in clinical patient care. Registration at German Clinical Trial Register (DRKS): DRKS00005285. •SdLDL/LDL ratio is increased in various chronic inflammatory diseases.•Gender difference in sdLDL/LDL ratio in rheumatoid arthritis.•SdLDL is not influenced by anti-cytokine therapy.