Low levels of a good cholesterol enzyme bad for artery disease

December 17, 2001

DALLAS, Dec. 18 - An enzyme that breaks up lipids in high-density lipoprotein (HDL - the "good" cholesterol), was associated with severity of coronary artery disease (CAD), according to a study in today's Circulation: Journal of the American Heart Association.

People with the lowest activity levels of an enzyme called hepatic lipase (HL) had 50 percent more severe CAD than those with the highest levels, says lead author Klaus A. Dugi, M.D., a researcher in the department of internal medicine at the University of Heidelberg, in Germany.

"Low hepatic lipase activity may help identify individuals who are at risk for coronary artery disease despite normal or high levels of HDL. In the future, drugs that affect HL activity may help prevent and treat CAD," he says.

HL activity in the blood was measured in 200 men undergoing elective coronary angiography. HL activity was determined in 23 patients with normal angiograms for comparison. Participants were given a CAD extent score, indicating the level of disease in their coronary arteries. Hepatic lipase breaks down triglycerides and phospholipids (fats) in circulating lipoproteins, but its importance to the development of cardiovascular disease is unclear.

The researchers found a significant inverse relationship between HL activity and CAD extent. HL activity was lower in 173 patients with CAD than in 40 controls with normal angiograms (286 nmol per mL, per minute vs. 338 nmol per mL, per min.). Further, when results were expressed in quartiles, HL activity in the lower quartiles was consistently associated with greater CAD extent. Individuals who had the highest hepatic lipase activity (top quartile), which was greater than 358 nmol, had an average extent score of 32.6. Those with the lowest HL activity - less than 213 nmol - had the highest CAD extent at 45.1.

Dugi plans further research to find out if low HL activity is linked to higher risk of heart attack.
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Co-authors include: Karin Brandauer; Nikolaus Schmidt; Barbara Nau; Jochen G. Schneider, M.D.; Stefani Mentz, M.D.; Tanja Keiper; Jeurgen R. Schaefer, M.D.; Christoph Meissner, M.D.; Horst Kather, M.D.; Malte L. Bahner, M.D.; Walter Fiehn, M.D.; and Joerg Kreuzer, M.D.

Editor's Note: The American Heart Association endorses the National Cholesterol Education Program (NCEP) guidelines for detection of high cholesterol. For more information on cholesterol guidelines, visit: http://www.americanheart.org/presenter.jhtml?identifier=4500.

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