Low HDL cholesterol level as an independent determinant of variant angina pectoris

Variant angina pectoris (VAP) is considered a distinctive manifestation of underlying coronary endothelial dysfunction. Although high-density lipoprotein has been shown to mediate vasodilation as a result of its endothelium-enhancing properties, the significance of a low high-density lipoprotein cholesterol (HDL-C) level in patients with VAP is still unclear. To investigate the association between a low level of HDL-C and VAP, 174 consecutive patients suspected of having VAP underwent an arterial spasm provocation test by direct injection of acetylcholine into the coronary arteries, yielding to 103 patients (59%) being diagnosed with VAP. There was a significant negative correlation between quartiles of HDL-C and presence of VAP. Multivariate analysis showed that belonging to the first HDL-C quartile was an independent predictor of VAP, along with cigarette smoking and impaired fasting glucose/diabetes mellitus. Moreover, patients in the fourth quartile of fasting plasma glucose or with cigarette smoking habit combined with belonging to the first HDL-C quartile showed an increased risk of VAP. A low level of HDL-C appears to be an independent determinant of VAP. Coronary endothelial dysfunction associated with low HDL-C levels may therefore play a role in the development of VAP.

Abstract

Keywords:
CHD – Diabetes – Endothelial dysfunction –HDL cholesterol – IFG – Plasma glucose – Smoking