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Lipoprotein Subfractions in Clinical Practice

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Therapeutic Lipidology

Part of the book series: Contemporary Cardiology ((CONCARD))

Abstract

Subfractionation methods provide increased granularity for size and density plasma lipoproteins. The prevailing hypothesis is that this increased granularity will isolate the most atherogenic measure of cholesterol. Plasma lipoproteins continuously change in size and composition in order to transport cholesterol and triglycerides between tissues. Several methods for measuring lipoprotein subfractions are commercially available including electrophoresis, nuclear magnetic resonance, ion mobility, and direct homogeneous enzymatic methods. The various methods measure different lipoprotein components, separate subfractions by different means, and define small, medium, and large by different limits. Consequently, concordance across methods is relatively poor. Smaller low-density lipoprotein (LDL) subfractions are associated with increased risk of atherosclerosis. However, this association is attenuated in models that account for basic lipid parameters such as total LDL cholesterol or apolipoprotein B. This suggests that the information provided by LDL subfractions is neither independent nor additive to standard lipid assessments. Subfractions of high-density lipoproteins have been controversial and often conflicting regarding which size fractions are associated with risk. No clinical society has recommended the use of subfractionation and several relevant organizations including the American Heart Association and the National Lipid Association specifically recommend against use of lipoprotein subfraction testing in clinical practice.

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Authors and Affiliations

  1. Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA

    Jeffrey W. Meeusen

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  1. Jeffrey W. Meeusen
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Correspondence to Jeffrey W. Meeusen .

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Editors and Affiliations

  1. The University of Chicago Pritzker School of Medicine, Chicago, IL, USA

    Michael H. Davidson

  2. Cicarrone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Univerity School of Medicine, Baltimore, MD, USA

    Peter P. Toth

  3. Department of Applied Health Science, Indiana University School of Public Health, Bloomington, IN, USA

    Kevin C. Maki

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Meeusen, J.W. (2021). Lipoprotein Subfractions in Clinical Practice. In: Davidson, M.H., Toth, P.P., Maki, K.C. (eds) Therapeutic Lipidology. Contemporary Cardiology. Humana, Cham. https://doi.org/10.1007/978-3-030-56514-5_27

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  • DOI: https://doi.org/10.1007/978-3-030-56514-5_27

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