Metabolic syndrome (MetS) represents a cluster of risk factors for cardiovascular disease (CVD), defined by the presence of ≥3 of the following 5 physiological risk factors:
- increased waist circumference,
- elevated blood pressure,
- low HDL cholesterol,
- elevated triglycerides,
- and elevated glucose.
Despite established diagnostic and treatment guidelines for MetS, the clinical evidence guiding the use of markers to predict MetS onset is still evolving.
One potential marker of MetS risk is oxidized LDL (oxLDL), which is formed when oxidative stress leads to modification of the apoB subunit on LDL cholesterol (LDL). Conversion of LDL to oxLDL appears to be an important event that helps initiate and accelerate the development of early atherosclerotic lesions, or fatty streaks. Cardiovascular sequelae of elevated oxLDL include coronary artery disease, acute myocardial infarction, stable and unstable angina, and untreated overt hypothyroidism. In a cross-sectional study of 3,987 non-diabetic individuals without symptoms of atherosclerosis, elevated oxLDL was strongly associated with prevalent MetS: odds ratios for the highest quartile ranged from 2.57 (95% CI 1.66-4.04) to 3.36 (95% CI 2.33-4.91), depending on which variables were adjusted for.
Measurement of oxLDL can also help in assessing the risk of MetS. A prospective, longitudinal study looked at oxLDL levels in 1,367 initially healthy adults in Finland. Individuals with elevated baseline oxLDL levels were more likely to develop MetS at 6-year follow-up, after adjusting for age, sex, smoking status, insulin resistance, body mass index, and C-reactive protein; however, the trend was not significant after also adjusting for apoB.
Similar findings were reported in another prospective, longitudinal study of 1,889 initially healthy adults in the United States. At 5-year follow-up, individuals in the highest quintile of oxLDL at baseline had 3.5 times the risk of developing MetS compared to those in the lowest quintile; individuals in the fourth quintile were at moderate risk (OR=2.8) for MetS.
Reference:
- Holvoet et al. JAMA. 2008; 299: 2287-2293 [L]
- Moore JX, Chaudhary N, Akinyemiju T. Metabolic syndrome prevalence by race/ethnicity and sex in the United States, National Health and Nutrition Examination Survey, 1988-2012. Prev Chronic Dis. 2017;14:4-5.
- Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol. A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. 2018:25709.
- Srikanthan K, Feyh A, Visweshwar H, et al. Systematic review of metabolic syndrome biomarkers: a panel for early detection, management, and risk stratification in the West Virginian population. Int J Med Sci. 2016;13:25-38.
- Gruzdeva O, Uchasova E, Dyleva Y, et al. Multivessel coronary artery disease, free fatty acids, oxidized LDL and its antibody in myocardial infarction. Lipids Health Dis. 2014;13:111.
- Salvayre R, Negre-Salvayre A, Camaré C. Oxidative theory of atherosclerosis and antioxidants. Biochimie. 2016;125:281-296.
- Steinberg D. Low density lipoprotein oxidation and its pathobiological significance. J Biol Chem. 1997;272:20963-20966.
- Oge A, Sozmen E, Karaoglu AO. Effect of thyroid function on LDL oxidation in hypothyroidism and hyperthyroidism. Endocr Res. 2004;30:481-489.
- Hurtado-Roca Y, Bueno H, Fernandez-Ortiz A, et al. Oxidized LDL is associated with metabolic syndrome traits independently of central obesity and insulin resistance. Diabetes. 2017;66:474-482.
- Koskinen J, Magnussen CG, Würtz P, et al. Apolipoprotein B, oxidized low-density lipoprotein, and LDL particle size in predicting the incidence of metabolic syndrome: the Cardiovascular Risk in Young Finns study. Eur J Prev Cardiol. 2012;19:1296-1303.
- Holvoet P, Lee DH, Steffes M, et al. Association between circulating oxidized low-density lipoprotein and incidence of the metabolic syndrome. JAMA. 2008;299:2287-2293.
- Harmon ME, Campen MJ, Miller C, et al. Associations of circulating oxidized LDL and conventional biomarkers of cardiovascular disease in a cross-sectional study of the Navajo population. PLoS One. 2016;11:e0143102.
Oxidized LDL
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