Small Dense Low-Density Lipoprotein Cholesterol and Coronary Artery Calcification in the Multi-Ethnic Study of Atherosclerosis

AIM

Elevated small dense-LDL-cholesterol (sd-LDL-C) increases atherosclerotic cardiovascular disease (CVD) risk. Although coronary artery calcium (CAC) is widely used for predicting CVD events, few studies have examined the relationship between sd-LDL-C and CAC.

METHODS

This study included 4672 individuals with directly-measured baseline sd-LDL-C and CAC from the Multi-Ethnic Study of Atherosclerosis (mean [SD] age: 61.9 [10.4] years; 52.5% women; 47.3% with baseline CAC [mean score >0]). We used multivariable general linear models and restricted cubic splines with goodness of fit testing to evaluate the association of sd-LDL-C with the presence of CAC. Odds ratios (OR [95% CI]) were adjusted for demographics and cardiovascular risk factors, including estimated total LDL-C.

RESULTS

Higher quartiles of sd-LDL-C were associated with presence of CAC, even after accounting for total LDL-C. Compared to the lowest quartile of sd-LDL-C, participants in Quartiles 2, 3 and 4 had higher odds for the presence of baseline CAC (Quartile 2 OR: 1.24 [1.00, 1.53]; Quartile 3 OR: 1.51 [1.19, 1.93]; and Quartile 4 OR 1.59 [1.17, 2.16]). Splines suggested a quadratic curvilinear relationship of continuous sd-LDL-C with CAC after adjustment for demographics and CVD risk factors (quadratic vs. first-order sd-LDL-C terms likelihood ratio test: p=0.015), but not after accounting for total LDL-C (quadratic vs. first-order terms: p=0.156).

CONCLUSIONS

In a large, multi-ethnic sample without known CVD, higher sd-LDL-C was associated with the presence of CAC, above and beyond total LDL-C. Whether selective direct measurement of sd-LDL-C is indicated to refine cardiovascular risk assessment in primary prevention warrants further investigation.

Transforming growth factor-beta protein and messenger RNA expression is increased in the closing ductus arteriosus

In full-term newborns, permanent closure of the ductus arteriosus is associated with the formation of a neointima that is characterized by extracellular matrix deposition and smooth muscle cell migration. Transforming growth factor-beta (TGF-beta), a potent modulator of extracellular matrix deposition and smooth muscle cell migration, has been found to play a role in the remodeling associated with several forms of vascular disease. We examined the protein and mRNA expression of the three mammalian isoforms of TGF-beta (TGF-beta1, TGF-beta2, and TGF-beta3) during ductus arteriosus closure in full-term lambs. We found that the temporal changes and cellular localization of the proteins and mRNAs of all three TGF-beta isoforms were similar. TGF-beta proteins and mRNAs were present in very low levels in the late-gestation fetal ductus. Within 24 h of delivery, there was enhanced expression of TGF-beta in the newly forming neointima and outer muscle media; this continued to increase over the next 10 d. Increased expression of TGF-beta in the inner muscle media and adventitia lagged behind that of the neointima and outer muscle media. TGF-beta was not found in the luminal endothelial cells at any time. In contrast to the pattern described above, the appearance of TGF-beta protein differed from that of mRNA in the vasa vasorum of the ductus wall. After delivery, there was an increase in TGF-beta immunoreactivity in the smooth muscle cell layers of the vasa vasorum without any concurrent mRNA expression. The appearance of TGF-beta at the time of ductus closure suggests an important role for this growth factor in the reorganization of the ductus wall after birth.

Transforming growth factor beta 1 inhibits fetal lamb ductus arteriosus smooth muscle cell migration

Anatomical closure of the ductus arteriosus (DA) requires normally quiescent smooth muscle cells (SMC) to migrate out of the muscle media into the subendothelial space, forming intimal mounds that eventually coalesce to occlude the vessel's lumen. Transforming growth factor-beta 1 (TGF beta 1), a potent modulator of vascular SMC migration, is found in the wall of the closing DA. We examined the effect of TGF beta 1 on the migration of fetal lamb DA-SMC. Although TGF beta 1 has been shown to be a chemoattractant for other mesenchymal cells, it had no chemotactic effect on DA-SMC; furthermore, TGF beta 1 did not enhance the migration of DA-SMC (as has been reported for aortic SMC). Rather, incubating DA-SMC with TGF beta 1 for 22 h decreased the rate of migration of SMC on extracellular matrix substrata composed of fibronectin, vitronectin, laminin, and collagen I and IV. Exposure of DA-SMC to TGF beta 1 was associated with an increase in the formation of focal adhesion plaques (tight associations between the cells' surface and extracellular matrix). DA-SMC use integrin receptors to attach to and migrate on extracellular matrix components. The decrease in DA-SMC migration was not associated with a significant change in the profile of integrin receptors expressed by the cell. TGF beta 1 had little effect on overall DA-SMC integrin expression, except for a modest increase in the fibronectin receptor (alpha 5 beta 1 integrin). Rather, the decrease in migration and changes in cell morphology were associated with an increased ability of integrin receptors to associate with the cytoskeleton. TGF beta 1 appears to anchor the cell's cytoskeleton to the extracellular matrix, making the cells more adherent and less capable of migrating.