Elevated levels of oxidized low density lipoprotein show a positive relationship with the severity of acute coronary syndromes

Circulation. 2001 Apr 17;103(15):1955-60. doi: 10.1161/01.cir.103.15.1955.


Background: There is accumulating data that acute coronary syndromes relate to recent onset activation of inflammation affecting atherosclerotic plaques. Increased blood levels of oxidized low density lipoprotein (ox-LDL) could play a role in these circumstances.

Methods and results: Ox-LDL levels were measured in 135 patients with acute myocardial infarction (AMI; n=45), unstable angina pectoris (UAP; n=45), and stable angina pectoris (SAP; n=45) and in 46 control subjects using a sandwich ELISA method. In addition, 33 atherectomy specimens obtained from a different cohort of patients with SAP (n=10) and UAP (n=23) were studied immunohistochemically for ox-LDL. In AMI patients, ox-LDL levels were significantly higher than in patients with UAP (P<0.0005) or SAP (P<0.0001) or in controls (P<0.0001) (AMI, 1.95+/-1.42 ng/5 microgram LDL protein; UAP, 1.19+/-0.74 ng/5 microgram LDL protein; SAP, 0.89+/-0.48 ng/5 microgram LDL protein; control, 0.58+/-0.23 ng/5 microgram LDL protein). Serum levels of total, HDL, and LDL cholesterol did not differ among these patient groups. In the atherectomy specimens, the surface area containing ox-LDL-positive macrophages was significantly higher in patients with UAP than in those with SAP (P<0.0001).

Conclusions: This study demonstrates that ox-LDL levels show a significant positive correlation with the severity of acute coronary syndromes and that the more severe lesions also contain a significantly higher percentage of ox-LDL-positive macrophages. These observations suggest that increased levels of ox-LDL relate to plaque instability in human coronary atherosclerotic lesions.

Publication types

  • Clinical Trial
  • Controlled Clinical Trial

MeSH terms

  • Angina Pectoris / blood*
  • Angina Pectoris / diagnosis
  • Angina Pectoris / surgery
  • Angina, Unstable / blood*
  • Angina, Unstable / diagnosis
  • Angina, Unstable / surgery
  • Atherectomy, Coronary
  • Cholesterol / blood
  • Cholesterol, HDL / blood
  • Cholesterol, LDL / blood
  • Cohort Studies
  • Coronary Artery Disease / metabolism*
  • Coronary Artery Disease / pathology
  • Coronary Artery Disease / surgery
  • Enzyme-Linked Immunosorbent Assay / methods
  • Female
  • Humans
  • Immunohistochemistry
  • Lipoproteins, LDL / metabolism*
  • Macrophages / metabolism
  • Macrophages / pathology
  • Male
  • Middle Aged
  • Myocardial Infarction / blood*
  • Myocardial Infarction / diagnosis
  • Predictive Value of Tests
  • Risk Factors
  • Sensitivity and Specificity
  • Severity of Illness Index


  • Cholesterol, HDL
  • Cholesterol, LDL
  • Lipoproteins, LDL
  • oxidized low density lipoprotein
  • Cholesterol