What is the most important measurement of cholesterol or lipids in the blood, when it comes to cardiovascular disease risk? LDL-C [low density lipoprotein cholesterol], is often called “bad cholesterol†because it is linked to atherosclerosis, but the landscape is always shifting. Even as cardiologists across the country get used to the new AHA/ACC guidelines, which call for changes in how physicians and patients view LDL-C, new research is focusing attention on other related markers. For example, a recent pair of studies in the New England Journal of Medicine identify gene mutations that lower both triglycerides and heart disease risk, suggesting that drugs that target that gene pathway could be beneficial. A new paper in Atherosclerosis, coauthored by Emory’s Terry Jacobson, looks at LDL-P, a different way of looking at LDL that has been proposed to be a better measure of cardiovascular disease risk. Jacobson is director of the Office of Health Promotion and Disease Prevention at Grady Health Systems. “To our knowledge this is the first large-scale real-world study investigating the potential benefit of LDL-P as an aid to patient management to prevent CHD/stroke events,†the authors write. LDL-C is the cholesterol content in LDL and LDL –P is the concentration of LDL particles. The research in the Atherosclerosis paper was sponsored by LipoScience, manufacturer of a blood test that measures LDL-P.
In a database of commercially insured patients, patients undergoing LDL-P measurement were more likely to receive intensive lipid-lowering therapy (like high dose statins) and had a lower risk of heart disease and stroke. This was not a randomized controlled clinical trial comparing two groups side by side, but the number crunching suggests that such a clinical trial using LDL-P measurements may be worthwhile.
Note: Liposcience’s materials suggest that you can, as a rule of thumb, divide LDL-P by ten to get LDL-C, but Fig. 1 in this paper makes it look like that approximation is inexact.
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