Low Density Lipoprotein Subclasses in Patients with Acute Coronary Syndrome, Hypertension and Hypertensive Heart Disease in South Africa

Abstract

The increase in the development of cardiovascular disease (CVD) has led to more investigations of the pivotal components 
imperative in the prevention and treatment of CVD. Analysis of lipid parameters with patient history has been crucial in risk
classification of patients and monitoring treatment. However, there are patients with acute coronary events with normal lipid 
parameters and family history, which led to the interest in atherogenic LDL sub-fractions. The objective was to observe the lipid 
profile and LDL species of patients with hypertension, hypertensive heart disease (HHD) and those with acute coronary syndrome 
(ACS). Method: Plasma from 92 patients was analysed using gradient gel electrophoresis (GGE), serum was analysed for total 
cholesterol (TC), LDL-C, HDL-C and triglyceride (TG). A self-administered questionnaire was used to collect demographics 
and relevant histories. A significantly low HDL-C concentration was observed across all patient groups (HTN p<0.001, HHD 
p<0.001, ACS p<0.001). Analysis of GGE images revealed that increased TG levels and low HDL-C levels associated with a 
predominance of LDL phenotype B. It was also observed that LDL-C levels exhibited no precipitating role in the development 
and progression from LDL phenotype A to I and B. Furthermore, not all patients with ACS had a predominance of LDL 
phenotype B. Conclusion: High TG levels displayed a causal role in the production of smaller LDL particles. The combination 
of low HDL-C and elevated TG levels were better indicators than the LDL-C level in association with the atherogenic LDL 
particles in assessment of CVD risk.