Ceramides—lipids that accumulate in tissues during hyperlipidemia and inflammation—are significantly associated with increased cardiovascular disease events, even among individuals with low low-density lipoprotein cholesterol (LDL-C) levels and no evidence of coronary stenosis. The findings point to ceramides as a “potentially better marker than LDL-C in predicting first and repeat cardiac events,” according to the study’s first author, Jeff Meeusen, PhD, co-director of cardiovascular laboratory medicine at Mayo Clinic in Rochester, Minnesota. Meeusen presented the findings in March at the American College of Cardiology’s 66th Annual Scientific Session.
Prior research found elevated ceramides levels in individuals with confirmed heart disease. In contrast to LDL-C’s artery-clogging properties, ceramides actively attract inflammatory cells and promote clotting, Meeusen explained in a prepared statement.
Meeusen and his colleagues followed for a median of 5.9 years 499 patients who had been referred for coronary angiography, assessing not only ceramides levels but also LDL-C, high-density lipoprotein cholesterol, triglycerides, C-reactive protein, and lipoprotein-associated phospholipase A2. The researchers defined coronary artery disease (CAD) as 50% stenosis in at least one coronary artery. Just 46% of patients had evidence of such a blockage. Overall, 5.1% of participants experienced cardiovascular events, including heart attack, stroke, revascularization, or death.
Grouping participants into risk scores based on ceramides levels—low (0–2), intermediate (3–6), moderate (7–9), and high (10–12)—the investigators found ceramides level significantly and independently associated with CAD after adjusting for both traditional novel cardiovascular risk factors. Meeusen and his colleagues found that for each one point increase in ceramides risk score, participants’ risk rose by 9%, even after adjustment for other risk factors. The rate of events was double in participants with the highest ceramides risk score in comparison to those with the lowest score.
The researchers also found higher versus lower ceramides risk scores associated with increased risk of cardiovascular events, even in participants with no evidence of CAD by angiography and in those with low LDL-C levels, 7.8% versus 2.2% and 16.4% versus 3.7% respectively. “Measuring ceramides offers another piece of information to help identify individuals who might need a little more attention, guide treatment decisions, and keep patients motivated to [live heart healthier],” according to Meeusen.