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

parate and break down lipoproteins. The SPIFE Lipoprotein analyzer (Helena Laboratories) offers lipoprotein phenotypingseparating lipoproteins into alpha, pre-beta and beta lipoproteins, as well as chylomicrons.

Beyond identifying risk, a patients lipoprotein distribution also can serve as a better indicator of treatment efficacy than the traditional lipid panel. Treatment efficiency varies with subfraction makeup as well. After implementing lifestyle and diet changes, the NCEP recommends the following drug treatments to lower LDL-C and raise HDL-C; HMG CoA reductase inhibitors (statins), bile acid sequestrants, nicotinic acids and Fibric acids. All of these treatments also lower triglyceride levels, with the exception of bile acid sequestrants. New evidence illustrates that small LDL particle concentration can be substantially reduced by statin combination therapy. Obtaining a clear breakdown of lipoprotein particle size and concentration can offer better, more individualized treatment methods than drugs designed to lower overall cholesterol levels.

In fact, if treatment with an LDL-lowering drug (statins are the primary drug of choice) is unsuccessful, the NCEP recommends combining treatments, and referring the patient to a lipid specialist if this tactic proves unsuccessful. As cholesterol testing evolves, new guidelines, studies and common practice are moving toward more specific, specialized testing that identifies each patients true risk, and offers more appropriate, effective, individualized treatment solutions.
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