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High Plasma Level of Remnant-Like Particles Cholesterol in Familial Combined Hyperlipidemia

Department of Medicine (J.d.G., G.M.v.d.V., E.t.A., A.F.H.S.), Division of General Internal Medicine, Radboud University Nijmegen Medical Centre, 6500 HB Nijmegen, The Netherlands; and Laboratory of Vascular Medicine (G.M.D.-T.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands

Address all correspondence and requests for reprints to: Jacqueline de Graaf, M.D., Ph.D., Department of Medicine, Division of General Internal Medicine 463, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands. E-mail: J.degraaf{at}aig.umcn.nl.

Context: The traditional lipid and lipoprotein levels in patients with familial combined hyperlipidemia (FCH) are relatively mildly elevated and do not fully explain the increased risk of cardiovascular disease (CVD). In other populations, high remnant-like particles cholesterol (RLP-C) levels are an independent risk factor for CVD.

Objective: The objective of the study was to investigate whether plasma RLP-C concentrations are elevated in patients with FCH and contribute to the increased prevalence of CVD.

Design, Setting, Participants: In this cross-sectional study, we studied RLP-C levels in 37 FCH families comprising 582 subjects, of whom 134 subjects were diagnosed FCH based on total cholesterol, triglyceride, and apolipoprotein-B levels. Plasma RLP-C concentrations were determined using an immune-separation technique.

Results: For both men and women, the mean plasma RLP-C concentration (mmol/liter) was 2-fold elevated in FCH patients [0.59 (0.54–0.66) and 0.40 (0.37–0.43), respectively] compared with both normolipidemic relatives [0.27 (0.26–0.29) in male and 0.22 (0.21–0.23) in female, all P < 0.000]; and spouses [0.27 (0.23–0.31) in male and 0.24 (0.21–0.27) in female, all P <0.000]. Plasma RLP-C levels above the 90th percentile predicted prevalent CVD, independently of nonlipid cardiovascular risk factors [odds ratio 2.18 (1.02–4.66)] and triglyceride levels [odds ratio 2.35 (1.15–4.83)]. However, in both FCH patients and controls, RLP-C did not provide additional information about prevalent CVD over and above non-high-density lipoprotein cholesterol levels.

Conclusions: Patients with FCH have 2-fold elevated plasma RLP-C levels, which add to the atherogenic lipid profile and contribute to the increased risk for CVD. However, for clinical practice, non-high-density lipoprotein cholesterol is the best predictor of prevalent CVD.

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