ABC | Volume 114, Nº3, March 2020

Original Article Discordance of Low-Density Lipoprotein Cholestrol and Non-High-Density Lipoprotein Cholestrol and Coronary Artery Disease Severity Ozge Kurmus, 1 Aycan Fahri Erkan, 1 Berkay Ekici, 1 Turgay Aslan, 1 Murat Eren 1 Ufuk University Faculty of Medicine – Cardiology, 1 Ankara – Turkey Mailing Address: Murat Eren • Ufuk University Faculty of Medicine, Cardiology, Dr. Rıdvan Ege Training and Research Hospital, Balgat 86-88, Ankara 06520 – Turkey E-mail: mrteren@hotmail.com Mansucript received February 05, 2019, revised manuscript April 08, 2019, accepted May 15, 2019 DOI: https://doi.org/10.36660/abc.20190091 Abstract Background: A sizeable proportion of patients have discordant low-density lipoprotein cholesterol (LDL-C) and non‑high‑density lipoprotein cholesterol (non-HDL-C). Objectives: We assessed the relationship between discordance of LDL-C and non-HDL-C and coronary artery disease (CAD) severity. Methods: We retrospectively evaluated the data of 574 consecutive patients who underwent coronary angiography. Fasting serum lipid profiles were recorded, SYNTAX and Gensini scores were calculated to establish CAD complexity and severity. We determined the medians for LDL-C and non-HDL-C to examine the discordance between LDL-C and non-HDL-C. Discordance was defined as LDL-C greater than or equal to the median and non-HDL-C less than median; or LDL-C less than median and non-HDL-C greater than or equal to median. A p value < 0.05 was accepted as statistically significant. Results: LDL-C levels were strongly and positively correlated with non-HDL-C levels (r = 0.865, p < 0.001) but 15% of patients had discordance between LDL-C and non-HDL-C. The percentage of patients with a Gensini score of zero or SYNTAX score of zero did not differ between discordant or concordant groups (p = 0.837, p = 0.821, respectively). Mean Gensini and SYNTAX scores, percentage of patients with Gensini score ≥20 and SYNTAX score >22 were not different from group to group (p = 0.635, p = 0.733, p = 0.799, p = 0.891, respectively). Also, there was no statistically significant correlation between LDL-C and Gensini or SYNTAX scores in any of the discordant or concordant groups. Additionally, no correlation was found between non-HDL-C and Gensini or SYNTAX score. Conclusions: While there was discordance between LDL-C and non-HDL-C (15% of patients), there is no difference regarding CAD severity and complexity between discordant and concordant groups. (Arq Bras Cardiol. 2020; 114(3):469-475) Keywords: Coronary Artery Disease/physiopathology; Atherosclerosis; Lipoproteins, LDL; Lipoproteins, HDL; Discordance. Introduction Low-density lipoprotein-cholestrol (LDL-C) is a risk factor for both new-onset coronary heart disease and recurrent coronary events. 1 The main target of lipid-lowering therapy is to prevent atherosclerotic events. 1,2 However, despite the achivement of low levels of LDL-C with treatment or having basal low levels of LDL without treatment, some patients still experience adverse events. 3 Non-high-density lipoprotein cholestrol (non-HDL-C) contains cholestrol in all potential atherogenic lipid particles including LDL, intermediate-density lipoprotein and very‑low‑density lipoprotein (VLDL). Some studies suggest that non-HDL-C is a better predictor of cardiovascular disease mortality than LDL-C. 4-6 The recommendation is to reduce non-HDL-C as a secondary lipid-lowering target. 1,2 But not all patients have concordant LDL-C and non-HDL-C levels. Studies have shown that a sizeable proportion of patients presents low LDL-C and high non-HDL-C or high LDL-C and low non-HDL-C. 7,8 It is not yet clear whether the discordance between LDL-C and non-HDL-C predicts severity and prognosis of coronary artery disease (CAD). Therefore, we detected the discordance of LDL-C and non-HDL-C, and assessed the relationship between this discordance and CAD severity in patients who had undergone coronary angiography. Methods Study Population This retrospective study assessed the data of 892 patients who had undergone coronary angiography between January 2017 and June 2018 in our angiography laboratory because of suspected stable coronary artery disease. Among these, 318 patients were excluded; 3 had incomplete data, 8 had 469