Journal of Preventive Cardiology
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Review Article

Year: 2016 I  Volume: 6I  Issue: 1I  Pages:965–972
Looking beyond LDL-Cholesterol level at LDL particle number
Soumitra Kumar*, Chanchal Samanta†, Soutrik Kumar‡
*Professor and Head of the Department (Cardiology), Vivekananda Institute of Medical Sciences, Kolkata.
†Post-graduate trainee (MD-Medicine), Vivekananda Institute of Medical Sciences, Kolkata.
‡Junior Resident, Department of Medicine, KPC Medical College, Kolkata.



Low-density lipoprotein cholesterol (LDL-C) level is an established cardiovascular disease (CVD) risk marker based on the results of various clinical trials. Most lipid lowering strategies are focused on reducing LDL-C to reduce cardiovascular risk. However, ample evidences show that LDL-C measurement and treatment alone is not the optimal strategy for reducing CVD risk.

Controversy remains whether we are using the best measure(s) of LDL-C characteristics to identify all individuals who are at CVD risk or if they would gain from specific therapies. Despite successful LDL-C reduction trials, considerable numbers of patients suffer from cardiovascular events in the treatment groups.

LDL-C measurement may not reflect a patient's true LDL-related risk due to the variable cholesterol content of LDL particles. Mismatch increases to one in two in the presence of diabetes mellitus, hypertriglyceridemia, low high-density lipoprotein cholesterol (HDL-C), or low LDL-C level. Various limitations make LDL-C a less accurate marker of CVD risk than non-HDL-C, LDL particle number (LDL-P), or apolipoprotein B (apoB).

Other triglyceride-rich lipoproteins including very-low-density lipoprotein (VLDL) remnants and intermediate-density lipoproteins (IDL) are also atherogenic.

The size of LDL particles and assessment of LDL-P by nuclear magnetic resonance spectroscopy have been suggested as a more reliable cardiovascular risk marker. Because the cholesterol content per LDL particle exhibits large inter-individual variation, the information provided by LDL-C and LDL-P is not equivalent.1-7 Individuals with the same level of LDL-C may have higher or lower LDL-P, and therefore, may differ in terms of absolute CVD risk.1-7 Higher LDL-P indicates higher risk and an opportunity for further LDL management.1-7

Recent studies investigated the importance of LDL-particle size. People with predominantly small and dense LDL particles have a threefold greater risk of coronary heart disease. The large and fluffy type of LDL may also be protective.

LDL particle number and size may be used more often in the future to assess cardiovascular risk. Here, we discuss the role of LDL-P as a more appropriate cardiovascular risk marker beyond LDL-C.

Cardiovascular disease
Low-density lipoprotein cholesterol
Low-density lipoprotein particle number
Non-high-density lipoprotein cholesterol
Nuclear magnetic resonance
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Journal of Preventive Cardiology
Print ISSN: 2249-4308
Online ISSN: 2277-6559
Frequency: Quarterly
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