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Comprehensive Lipid Profiling Beyond LDL

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Asymptomatic Atherosclerosis

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

Abstract

Although many trials have documented the benefits of lowering plasma LDL cholesterol levels for the primary and secondary prevention of cardiovascular disease (CVD), about two thirds of CVD cases cannot be prevented. As CVD morbidity and mortality rates continue to increase in developed and developing societies, despite several improvements in CVD management, this observation suggests that other risk factors beyond LDL cholesterol and other traditional CVD risk factors may yield new insights into the assessment and management of CVD risk. It is now well-recognized that abdominally obese and insulin-resistant individuals have a strong tendency to develop a typical dyslipidemia that is independent of LDL cholesterol levels. This typical dyslipidemia has been called “atherogenic” dyslipidemia in the ATP-III guidelines, which is in fact a misnomer because it implies that other dyslipidemias are not atherogenic. This atherogenic dyslipidemia usually accompanies a high intra-abdominal or visceral adipose tissue (VAT) accumulation and is often associated with elevated plasma levels of triglycerides and apolipoprotein B and with decreased HDL cholesterol and apolipoprotein A-I concentrations. It is also associated with an increased preponderance of small, dense LDL particles which have a stronger tendency to undergo oxidation, even among individuals with plasma LDL cholesterol levels in the normal range. Altogether, these observations suggest that currently available algorithms might not necessarily identify these abdominally obese and dyslipidemic individuals at increased CVD risk. The so-called “hypertriglyceridemic waist” phenotype, on the basis of a simple measurement of waist circumference in combination with plasma triglyceride levels, is a simple tool that can be easily used by general practitioners to identify people carrying atherogenic metabolic abnormalities which put them at increased CVD risk.

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Acknowledgments

Benoit J. Arsenault is recipient of a training scholarship from Hôpital Laval Research Centre. Jean-Pierre Després is the Scientific Director of the International Chair on Cardiometabolic Risk which is supported by an unrestricted grant awarded to Université Laval by Sanofi Aventis.

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Authors and Affiliations

  1. Department of Anatomy and Physiology, Université Laval, Quebec, QC, Canada

    Benoit J. Arsenault

  2. Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands

    S. Matthijs Boekholdt

  3. Academic Medical Center, Amsterdam, The Netherlands

    John J. P. Kastelein

  4. Québec Heart Institute, Montreal, Quebec, QC, Canada

    Jean-Pierre Després

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  1. Benoit J. Arsenault
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  2. S. Matthijs Boekholdt
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  3. John J. P. Kastelein
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  4. Jean-Pierre Després
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  1. Endothelix, Inc., El Rio 8275, Houston, 77054, USA

    Morteza Naghavi

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Arsenault, B.J., Boekholdt, S.M., Kastelein, J.J.P., Després, JP. (2011). Comprehensive Lipid Profiling Beyond LDL. In: Naghavi, M. (eds) Asymptomatic Atherosclerosis. Contemporary Cardiology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60327-179-0_8

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  • DOI: https://doi.org/10.1007/978-1-60327-179-0_8

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