Lipoprotein Subfraction Disorders:
This test measures the number of particles in each of the 8 LDL subclasses. Six of these 8 subclasses are small LDL subclass particles. These smaller particles are associated with rapid uptake into the endothelium contributing to accelerated atherosclerosis.
There is a 1.3-fold increased risk for Cardiovascular diseases associated with the small LDL trait and a 1.4-fold increased risk with the medium LDL trait.
Contributing Factors:
Genetics/demographics:
- Genetic predisposition
- High triglyceride and low HDL-C levels
Lifestyle:
- High consumption of simple carbohydrates
- Overweight or obese
- Sedentary lifestyle
Illness:
- Insulin resistance/diabetes mellitus/ metabolic syndrome
Drugs:
- Nonselective beta blockers
Treatment Considerations:
Dietary/lifestyle intervention:
- Avoid simple carbohydrate diet
- Fat weight loss
- Regular exercise
- Omega-3 fish oil
Pharmacological intervention:
- Thiazolidinediones
- Nicotinic acid
- Fibrates
- Statins (minor effect. effect is specific to atorvastatin)
Disease intervention:
- Consider evaluation of cardiometabolic function
- Noninvasive imaging
- Additional blood tests
- Identify and correct insulin resistance
- Control diabetes mellitus
References:
Mann DL, Zipes DP, Libby P, Bonow RO. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed: Saunders. 2015.
Hoogeveen RC, Gaubatz JW, Sun W, et al. Small dense low-density lipoprotein-cholesterol concentrations predict risk for coronary heart disease: The Atherosclerosis Risk In Communities (ARIC) study. Arterioscler Thromb Vasc Biol. 2014;34:1069-1077.
Krauss RM. Dietary and genetic effects on low-density lipoprotein heterogeneity. Annu Rev Nutr. 2001;21: 283-295.
Iacobellis G. Obesity and Cardiovascular Disease: Oxford University Press. 2009.
Slentz CA, Houmard JA, Johnson JL, et al. Inactivity, exercise training and detraining, and plasma lipoproteins. STRRIDE: a randomized, controlled study of exercise intensity and amount. J Appl Physiol (1985). 2007;103:432-442.
Campos H, Genest JJ, Jr., Blijlevens E, et al. Low density lipoprotein particle size and coronary artery disease. Arterioscler Thromb. 1992;12:187-195.
Griffin BA, Caslake MJ, Yip B, et al. Rapid isolation of low density lipoprotein (LDL) subfractions from plasma by density gradient ultracentrifugation. Atherosclerosis . 1990;83:59-67.
Betteridge DJ. Effects of pioglitazone on lipid and lipoprotein metabolism. Diabetes Obes Metab. 2007;9:640-647.
Superko HR, Krauss RM. Differential effects of nicotinic acid in subjects with different LDL subclass patterns. Atherosclerosis . 1992;95:69-76.
Staels B, Dallongeville J, Auwerx J, et al. Mechanism of action of fibrates on lipid and lipoprotein metabolism. Circulation . 1998;98:2088-2093.
Sniderman AD. Differential response of cholesterol and particle measures of atherogenic lipoproteins to LDL-lowering therapy: Implications for clinical practice. J Clin Lipidol. 2008;2:36-42.
Brunzell JD, Davidson M, Furberg CD, et al. Lipoprotein management in patients with cardiometabolic risk: Consensus statement from the American Diabetes Association and the American College of Cardiology Foundation. Diabetes Care. 2008;31:811-822.
Marzullo P, Mariani G. From Basic Cardiac Imaging to Image Fusion. Core Competencies Versus Technological Progress: Springer. 2013.
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Contributing Factors:
Genetics/demographics:
- Genetic predisposition
- High triglyceride and low HDL-C levels
Lifestyle:
- High consumption of simple carbohydrates
- Overweight or obese
- Sedentary lifestyle
Illness:
- Insulin resistance/diabetes mellitus/ metabolic syndrome
Drugs:
- Nonselective beta blockers
Treatment Considerations:
Dietary/lifestyle intervention:
- Avoid simple carbohydrate diet
- Fat weight loss
- Regular exercise
- Omega-3 fish oil
Pharmacological intervention:
- Thiazolidinediones
- Nicotinic acid
- Fibrates
- Statins (minor effect. effect is specific to atorvastatin)
Disease intervention:
- Consider evaluation of cardiometabolic function
- Noninvasive imaging
- Additional blood tests
- Identify and correct insulin resistance
- Control diabetes mellitus
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Apolipoprotein A-1, Apolipoprotein B, Apolipoprotein B/A1 Ratio, Apoprotein B100 (ApoB 100), HDL Large, HDL Size, HDL-2, HDL-3, HDL-P, Large HDL-P, Large VLDL-P, LDL Medium, LDL Particle Number, LDL Pattern, LDL Peak Size, LDL Size, LDL Small, LDL-P, LDL1 Pattern A, LDL2 Pattern A, LDL3 Pattern B, LDL4 Pattern B, Lipoprotein (a), LP PLA2 ACTIVITY, LP-IR Score, Small LDL-P, VLDL Cholesterol Cal, VLDL Size, VLDL-3