Assessing complete lipid atherogenic risk burden

Assessing complete lipid atherogenic risk burden

Assessing complete lipid atherogenic risk burden: Even though LDL (low density lipoprotein) cholesterol is currently taken as the important marker of atherogenic risk due to lipids, it is only a partial marker. Complete lipid atherogenic risk burden assessment should take into account all other atherogenic cholesterol particles Lipoprotein (a) [Lp(a)], intermediate-density lipoprotein cholesterol (IDL-C), chylomicron remnants, and VLDL-C (very low density lipoprotein cholesterol).

Apolipoprotein B (apoB) is ideally suited for the direct measurement of all atherogenic lipoproteins together since each atherogenic particle contains 1 apoB100 molecule. Non–HDL-C on the other hand quantifies total atherogenic burden by measuring the total amount of cholesterol in all atherogenic particles taken together. Non–HDL-C = Total cholesterol – HDL-Cholesterol. It can be obtained in the non-fasting state without affecting the results as the components affected by a meal do not come in the equation. Non–HDL cholesterol is a secondary target of therapy as per the NCEP ATP III (National Cholesterol Education Program Adult Treatment Panel) guidelines. Non–HDL cholesterol has been shown to be an independent predictor of coronary artery disease regardless of triglyceride levels. But LDL cholesterol loses its predictive value with triglyceride levels above 400 mg/dl [Frost PH et al. Serum lipids and incidence of coronary heart disease. Findings from the Systolic Hypertension in the Elderly Program (SHEP). Circulation 1996;94:2381-2388].