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

rendering one more at risk for conditions such as CHD. The concentrations and sizes of the particles (LDL-C, small LDL, large HDL and large very-low-density lipoproteins) are better indicators of risk than the traditional lipid panel (Kraus et al, N Engl J Med 2002; 347:1483-92).

While a standard LDL-C panel may place a patient in the at-risk range for CAD, the breakdown of LDL subfractions may show that the patient is in fact, not at risk preventing overtreatment. In other cases, for patients that fall outside the traditional risk range, or near the border, an LDL particle breakdown may show that they in fact are at risk of CAD, due to an unhealthy distribution of particles. Accordingly, a number of tests have been developed that focus on lipid particle size and density.

The Lipoprint (Quantimetrix) was designed to do just that. The test uses a gel electrophoresis method to examine lipoprotein subfractions, including 12 cholesterol parameters. The Lipoprint identifies small, dense atherogenic particles that indicate a higher risk of metabolic syndrome and coronary events. Each patient receives a color-coded graphical representation of their particle breakdown and subsequent risk. The NMR LipoProfile (LipoScience, Inc.) also measures LDL particle size and distribution, by nuclear magnetic resonance spectroscopy blood test. The LipoProfile identifies the average size of LDL particles (in units of nanomoles of particles per liter), linking a greater distribution of small particles with the greatest risk for developing CHD and Type 2 Diabetes Mellitus. Patients with a high distribution of large LDL particles are at a lesser, but still significant risk for CHD. The VAP (Atherotech) also measures LDL particle size and density, in addition to hereditary risk factor and remnant lipoprotein, giving a more accurate depiction of the patients risk for CAD, CHD and metabolic syndrome.

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