Usefulness of low-density lipoprotein particle size measurement in cardiovascular disease prevention

Abstract

SummaryBackground: Cardiovascular disease is largely explained by the traditional risk factors, but there are several novel risk factors that have been shown to predict cardiovascular morbidity. The measurement of low-density lipoprotein particle size (LDLPS) is a novel cardiovascular risk factor, yet it is unknown whether this measurement provides additional information that may influence the subsequent medical treatment of patients.Hypothesis: The measurement of LDLPS provides additional information that may influence preventive treatment for cardiovascular disease.Methods: In an observational study of 82 patients referred to a tertiary care preventive cardiology clinic, LDLPS was dichotomized as either small or large and was determined by either the NMR LipoProfile test, the Vertical Auto Profile (VAP ™ ) cholesterol test, or gradient gel electrophoresis. Lipid profiles were obtained and Framingham risk scores were calculated. Patients were stratified by Adult Treatment Panel guidelines as being at low, intermediate, or high risk.Results: The study included 56 men and 26 women with a mean age of 54 ± 11 years. In the entire cohort of 82 patients, only 31 (38%) were at non-high-density lipoprotein (HDL) goal, only 21 (26%) were at goals for both non-HDL and HDL, and only 18 (22%) were at goal for non-HDL, HDL, and triglycerides. When considering each of the risk factor strata, 19 of 43 (44%) low-risk patients were at non-HDL goal and 12 of these also had a small LDLPS. Only 8 of 18 (44%) intermediate-risk patients were at non-HDL goal and 7 of these (88%) had small LDLPS. Finally, only four high-risk pa-

Very Large Database of Lipids: Rationale and Design

“…Population density distributions of TC, HDL‐C, TG, Friedewald LDL‐C, non–HDL‐C, and the TC to HDL‐C ratio (Figure ) are nearly identical as shown by superimposable curves of lipid distributions from adults in the VLDL database and population‐representative National Health and Nutrition Examination Survey (NHANES) 2007 to 2008. In VLDL adults, the median directly measured LDL‐C is 108 mg/dL (2.79 mmol/L) and IQR 85 to 135 mg/dL (2.20–3.49 mmol/L).…”

“…For population‐based treatment purposes, worldwide guidelines predominantly categorize patients according to low‐density lipoprotein cholesterol (LDL‐C) levels, estimated by the Friedewald equation . However, there is great interest in further refining categorizations of abnormal lipid metabolism . Although levels of high‐density lipoprotein cholesterol (HDL‐C) and triglycerides (TG) are most commonly used for assessment beyond LDL‐C, even more granularity to lipid characterization is possible by using multiple complementary methods.…”

Clinical applications of advanced lipoprotein testing in diabetes mellitus

“…nHDL-C has been demonstrated to be a stronger predictor for CVD risk than traditional LDL-C [17], and elevated levels were still associated with an increased risk of coronary heart disease with LDL levels below 100 mg/dl [18]. However, many individuals who reach their respective nHDL-C targets nevertheless still possess an atherogenic lipid profile with residual risk [19]. Recent studies demonstrated that apoB may be superior to both nHDL-C and LDL-C as a predictor of CVD [20].…”

NMR and Metabolomics—A Roadmap for the Future

“…LipoScience was initially dedicated to performing research on NMR-based cholesterol testing using plasma and serum samples. This effort eventually led to the development of a successful FDA-approved LDL test called LipoProfile in 2005 [ 63 ]. The LipoProfile NMR test is highly automated and provides 11 different measures of lipoprotein concentrations and sizes from plasma samples.…”