Low-density lipoprotein particle number is associated with different presentations of coronary artery disease recurrence: data from the UK biobank

Abstract Background and Purpose The prognostic value of low-density lipoprotein (LDL) particle number compared to LDL cholesterol concentration in predicting outcomes of coronary artery disease (CAD) remains unclear. However, given that a high number of small LDL particles can increase plaque instability, differences in the mode of presentation of CAD recurrence may exist depending on LDL particle number. Methods Data were collected from 3,785 patients with a history of myocardial infarction (MI) from the UK Biobank. Log-transformed LDL particle number and apolipoprotein B levels, measured using metabolomics, were analyzed. Recurrent coronary events were defined as coronary revascularization, myocardial infarction, or related death. Cox proportional hazards regression models were used to evaluate the associations between LDL particle number and coronary events. Results Over a median follow-up of 11.3 years (interquartile range IQR 9.0–12.3), 1,007 (26.6%) patients experienced a recurrent coronary event, of which 269 (26.7%) were recurrent MI and/or related deaths. Patients with recurrent coronary events had significantly higher LDL particle numbers than those without (p0.001). While dyslipidemia (hazard ratio HR 1.66, 95% confidence interval CI 1.24–2.21), diabetes mellitus (HR 1.63, 95% CI 1.42–1.89), and current smoking (HR 1.59, 95% CI 1.36–1.87) were significantly associated with the occurrence of all coronary events, LDL particle number was not independently associated with the overall risk. However, when the analysis was restricted to recurrent MI and/or related death, LDL particle number showed the strongest association (HR 3.53, 95% CI 1.16–10.83). Similarly, apolipoprotein B, a commonly used surrogate marker for LDL particle number, was associated with recurrent MI and/or related death (HR 4.65, 95% CI 1.41–15.32) but not with all coronary events. Conclusions A high LDL particle number is associated with an increased likelihood of severe recurrence of myocardial infarction and/or related death in coronary artery disease. While LDL particle number may not significantly predict the overall occurrence of recurrent coronary events, it could serve as a valuable predictor of recurrence severity, particularly for severe outcomes.LDL particle number and mode of presenta