Usefulness of low-density lipoprotein particle size measurement in cardiovascular disease prevention.

BACKGROUND: Cardiovascular disease is largely explained by the traditional risk factors, but there are several novel risk factors that have been shown to predict cardiovascular morbidity. The measurement of low-density lipoprotein particle size (LDLPS) is a novel cardiovascular risk factor, yet it is unknown whether this measurement provides additional information that may influence the subsequent medical treatment of patients. HYPOTHESIS: The measurement of LDLPS provides additional information that may influence preventive treatment for cardiovascular disease.
METHODS: In an observational study of 82 patients referred to a tertiary care preventive cardiology clinic, LDLPS was dichotomized as either small or large and was determined by either the NMR LipoProfile test, the Vertical Auto Profile (VAP) cholesterol test, or gradient gel electrophoresis. Lipid profiles were obtained and Framingham risk scores were calculated. Patients were stratified by Adult Treatment Panel guidelines as being at low, intermediate, or high risk.
RESULTS: The study included 56 men and 26 women with a mean age of 54 +/- 11 years. In the entire cohort of 82 patients, only 31 (38%) were at non-high-density lipoprotein (HDL) goal, only 21 (26%) were at goals for both non-HDL and HDL, and only 18 (22%) were at goal for non-HDL, HDL, and triglycerides. When considering each of the risk factor strata, 19 of 43 (44%) low-risk patients were at non-HDL goal and 12 of these also had a small LDLPS. Only 8 of 18 (44%) intermediate-risk patients were at non-HDL goal and 7 of these (88%) had small LDLPS. Finally, only four high-risk patients were at non-HDL goal and three of these (75%) had small LDLPS.
CONCLUSIONS: Knowing the LDLPS could alter subsequent therapeutic recommendations for most patients who have reached target lipid values.