Lipoprotein Subfraction Disorders:
This test identifies 5 subclasses of HDL, 1 is identified as the large HDL subclass. Decreased levels of the large HDL subclass are associated with a 1.8-fold increased risk for CVD. Large HDL particles are functionally associated with an antioxidant, paraoxanase, which may help protect the arterial wall.
Contributing Factors:
Genetics/demographics:
- Genetic predisposition
- High triglyceride levels
Lifestyle:
- High consumption of simple carbohydrates
- Overweight or obese
- Sedentary lifestyle
- Smoking
Illness:
- Insulin resistance/diabetes mellitus
- Liver, kidney, and thyroid disease
Drugs:
- Nonselective beta blockers, androgens, progestins
Treatment Considerations:
Dietary/lifestyle intervention:
- Avoid simple dietary carbohydrates
- Fat weight loss
- Regular exercise
- Smoking cessation
- Omega-3 fish oil
Pharmacological intervention:
- Nicotinic acid
- Nicotinic acid plus statin
Statins (minor effect)
- Fibrates when triglyceride levels are elevated
Disease intervention:
- Correct insulin resistance
- Control diabetes mellitus
References:
Kasper D, Fauci A, Hauser S, et al. Harrison’s Principles of Internal Medicine. 19th ed: McGraw-Hill Education. 2015.
Mann DL, Zipes DP, Libby P, Bonow RO. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed: Saunders. 2015.
Siri-Tarino PW, Sun Q, Hu FB, Krauss RM. Saturated fatty acids and risk of coronary heart disease: Modulation
by replacement nutrients. Curr Atheroscler Rep. 2010;12:384-390.
Page ST, Krauss RM, Gross C, et al. Impact of mifepristone, a glucocorticoid/progesterone antagonist, on HDL cholesterol, HDL particle concentration, and HDL function.J Clin Endocrinol Metab. 2012;97:1598- 1605.
Annuzzi G, Rivellese AA, Wang H, et al. Lipoprotein subfractions and dietary intake of n-3 fatty acid: The Genetics of Coronary Artery Disease in Alaska Natives study. Am J Clin Nutr. 2012;95:1315-1322.
HDL Large
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