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Elevated Remnant-Like Particle Cholesterol and Triglyceride Levels in Diabetic Men and Women in the Framingham Offspring Study

¹ Lipid Research Laboratory, Division of Endocrinology, Diabetes, Metabolism, and Molecular Medicine, New England Medical Center, Boston, Massachusetts
² Otsuka America Pharmaceutical, Rockville, Maryland
³ Department of Epidemiology and Biostatistics, Boston University School of Public Health, Boston, Massachusetts
⁴ National Heart, Lung, & Blood Institute’s Framingham Heart Study, National Institutes of Health, Framingham, Massachusetts

OBJECTIVE—Remnants of triglyceride-rich lipoproteins are thought to be atherogenic. A new antibody-based assay allows for the isolation of remnant-like particles (RLPs) from plasma or serum, and the subsequent measurement of RLP cholesterol (RLPC) and triglycerides (RLPTGs). We hypothesized that diabetic patients would have higher remnant levels than nondiabetic patients.

DESIGN AND METHODS—We compared RLPC and RLPTG levels of diabetic subjects (68 women, 121 men) participating in the Framingham Heart Study with those of nondiabetic subjects (1,499 women, 1,357 men).

RESULTS—Mean RLPC values for diabetic women were 106% higher than those for nondiabetic women (0.367 ± 0.546 mmol/l [14.2 ± 21.1 mg/dl] vs. 0.179 ± 0.109 mmol/l [6.9 ± 4.2 mg/dl]; P < 0.0001), and RLPTG values for diabetic women were 385% higher than those for nondiabetic women (1.089 ± 2.775 mmol/l [93.1 ± 245.6 mg/dl] vs. 0.217 ± 0.235 mmol/l [19.2 ± 20.8 mg/dl]; P < 0.0001). Similar but less striking differences were observed in diabetic men, who had mean RLPC values 28% higher than those seen in nondiabetic men (0.285 ± 0.261 mmol/l [11.0 ± 10.1 mg/dl] vs. 0.223 ± 0.163 mmol/l [8.6 ± 6.3 mg/dl]; P < 0.001) and mean RLPTG values 70% higher than those seen in nondiabetic men (0.606 ± 1.019 mmol/l [53.6 ± 90.2 mg/dl] vs. 0.357 ± 0.546 mmol/l [31.6 ± 48.3 mg/dl]; P < 0.001). Moreover, diabetic men and women had significantly higher total triglycerides and lower HDL cholesterol levels than nondiabetic subjects.

CONCLUSIONS—The data indicate that RLP particles are elevated in diabetic subjects. To achieve optimal reduction of risk for cardiovascular disease, treatment of elevated RLP values, along with the control of LDL cholesterol levels, should be considered.

Abbreviations: apo, apolipoprotein • CHD, coronary heart disease • CVD, cardiovascular disease • DBP, diastolic blood pressure • FHS, Framingham Heart Study • HDLC, HDL cholesterol • HMG, hydroxymethylglutaryl • LDLC, LDL cholesterol • NCEP, National Cholesterol Education Program • RLP, remnant-like lipoprotein particle • RLPC, RLP cholesterol • RLPTG, RLP triglyceride • SBP, systolic blood pressure • VA-HIT, Veterans Affairs HDL Intervention Trial

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