Discordance Between Ldl Cholesterol Versus Particle Concentration And The Cardiovascular Risk Factor Profile

Although low-density lipoprotein cholesterol (LDL-C) levels have been associated with cardiovascular disease (CVD) risk, subjects with well controlled LDL-C are still at considerable residual risk for CVD. Alternative measures such as particle concentration of LDL (LDL-P) may be clinically useful for fully characterizing LDL associated risk. PURPOSE: To compare CVD risk factor profiles among groups of people with discordant levels of LDL-C versus LDL-P concentration in the HERITAGE Family Study. METHODS: Standard lipid panels and lipoprotein subclass profiles via nuclear magnetic resonance (NMR) spectroscopy were measured among 715 participants (34% Black, 55% Female). LDL-C and LDL-P values ≥ the median value were considered high and values < median were considered low. Four exclusive LDL-C/LDL-P groups were identified for LDL from these base categories: 1) low/low (< median for both LDL-C and LDL-P), 2) low/high (< median for LDL-C, ≥ median for LDL-P), 3) high/low, and 4) high/high. Cross-sectional associations between baseline LDL discordance group and CVD risk factors were assessed via multivariable linear regression. All models were adjusted for age, race, and sex. RESULTS: Sixty four (9.0%) participants were discordant with high LDL-C/low LDL-P, while 61 (8.5%) were discordant with low LDL-C/high LDL-P. Both concordant groups (low LDL-C/low LDL-P, high LDL-C/high LDL-P) were composed of 295 participants each (41.3%). Main effects (p<0.05) of LDL discordant group were found for the following outcomes: triglycerides, HDL-C, HDL-P size and small and large HDL-P concentration, percent body fat, maximal oxygen uptake, fasting insulin, lipoprotein lipase activity, testosterone, GlycA, and C-reactive protein. In general, groups with lower LDL-P had more favorable CVD risk factor profiles relative to high LDL-P groups. CONCLUSIONS: In general, low LDL-P levels were associated with favorable CVD risk factor profiles regardless of LDL-C levels.