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Triglycerides, hypertension, and smoking predict cardiovascular disease in dysbetalipoproteinemia

  • Martine Paquette
    Affiliations
    Lipids, Nutrition and Cardiovascular Prevention Clinic of the Montreal Clinical Research Institute, Québec, Canada
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  • Sophie Bernard
    Affiliations
    Lipids, Nutrition and Cardiovascular Prevention Clinic of the Montreal Clinical Research Institute, Québec, Canada

    Division of Endocrinology, Department of Medicine, Université de Montreal, Québec, Canada
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  • Guillaume Paré
    Affiliations
    Genetic Molecular Epidemiology Lab, Population Health Research Institute, Ontario, Canada
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  • Alexis Baass
    Correspondence
    Corresponding author. Alexis Baass, Lipids, Nutrition and Cardiovascular Prevention Clinic of the Montreal Clinical Research Institute, 110 avenue des Pins Ouest, Montreal, Québec H2W 1R7, Canada.
    Affiliations
    Lipids, Nutrition and Cardiovascular Prevention Clinic of the Montreal Clinical Research Institute, Québec, Canada

    Divisions of Experimental Medicine and Medical Biochemistry, Department of Medicine, McGill University, Québec, Canada
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Published:December 24, 2019DOI:https://doi.org/10.1016/j.jacl.2019.12.006

      Highlights

      • Dysbetalipoproteinemia (DBL) is a rare autosomal recessive lipid disorder.
      • DBL is associated with an increased cardiovascular disease (CVD) risk.
      • Triglycerides, hypertension, and smoking are independent predictors of CVD in DBL.

      Background

      Dysbetalipoproteinemia (DBL) is an autosomal recessive lipid disorder associated with a reduced clearance of remnant lipoproteins and is associated with an increased cardiovascular disease (CVD) risk. The genetic cause of DBL is apoE2 homozygosity in 90% of cases. However, a second metabolic hit must be present to precipitate the disease. However, no study has investigated the predictors of CVD, peripheral artery disease and coronary artery disease in a large cohort of patients with DBL.

      Objective

      The objectives of this study were to describe the clinical characteristics of a DBL cohort and to identify the predictors of CVD, peripheral artery disease, and coronary artery disease in this population.

      Methods

      The inclusion criteria included age ≥ 18 years, apoE2/E2, triglycerides (TG) > 135 mg/dL and VLDL-C/plasma TG ratio > 0.30.

      Results

      We studied 221 adult DBL patients, of which 51 (23%) had a history of CVD. We identified 3 independent predictors of CVD, namely hypertension (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 TG tertile (OR 1.82, 95% CI 1.09–3.05, P = .02). The CVD prevalence was 51% in patients with hypertension and 18% in those without hypertension (P = .00001), and 30% in the highest TG tertile vs 15% in the lowest tertile (P = .04). Similarly, the CVD prevalence was higher in heavy smokers compared with nonsmokers (36% vs 13%, P = .006).

      Conclusion

      Hypertension, smoking, and TG are independently associated with CVD risk in patients with DBL. Aggressive treatment should be initiated in patients with DBL because of the increased risk of CVD.

      Keywords

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