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Low-Density Cholesterol Subfractions: Not all LDL-C Particles are Created Equal


Kerri Penno
Contributing Editor

Medical conventions are challenged every day. Already in the new year, the effectiveness of cold medicine and the gold standard in breast cancer treatment have been challenged. Standards in cholesterol testing are the latest casualty of medical innovation.

For years, cholesterol has been measured by a simple panel of high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C); good and bad cholesterol. In the past couple of decades, the National Cholesterol Education Program (NCEP) recommendations have evolved from the total cholesterol test to a fasting lipoprotein profilecomprised of total cholesterol, HDL-C, LDL-C and triglycerides.

These guidelines have operated under the assumption that high levels of LDL-C are essentially harmful; LDL-C has been associated with coronary heart disease (CHD), coronary artery disease (CAD), metabolic syndrome and atherosclerosis. However, studies on cholesterol testing effectiveness have long shown that the guidelines may not be universally effective at identifying a patients risk of cardiac events. In 1988, a study on cholesterol lipids and CAD noted that 75 percent of patients who suffer myocardial infarctions have normal levels of HDL-C and LDL-C (Castelli, Can J Cardiol 1988 4A:5A). These insufficiencies have led to the revision of the guidelines and additional studies to measure risk factors.

The NCEP recently released The Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III, or ATP III), reiterating and expanding on the aforementioned guidelines. ATP III identified LDL-C as the primary target of cholesterol-lowering therapy.

Recent studies, however, show that not all LDL-C particles are created equal. Two patients with similar LDL-C levels may, in fact, have a different makeup of LDL-C particles,
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