title: Effects of cardiovascular lifestyle change on lipoprotein subclass profiles defined by nuclear magnetic resonance spectroscopy.
abstract: BACKGROUND
  Low-density lipoprotein (LDL) cholesterol lowering is a primary goal in clinical management of patients with cardiovascular disease, but traditional cholesterol levels may not accurately reflect the true atherogenicity of plasma lipid profiles. The size and concentration of lipoprotein particles, which transport cholesterol and triglycerides, may provide additional information for accurately assessing cardiovascular risk. This study evaluated changes in plasma lipoprotein profiles determined by nuclear magnetic resonance (NMR) spectroscopy in patients participating in a prospective, nonrandomized lifestyle modification program designed to reverse or stabilize progression of coronary artery disease (CAD) to improve our understanding of lipoprotein management in cardiac patients.
  
  
  RESULTS
  The lifestyle intervention was effective in producing significant changes in lipoprotein subclasses that contribute to CAD risk. There was a clear beneficial effect on the total number of LDL particles (-8.3%, p < 0.05 compared to matched controls), small dense LDL particles (-9.5%, p < 0.05), and LDL particle size (+0.8%; p < 0.05). Likewise, participants showed significant improvement in traditional CAD risk factors such as body mass index (-9.9%, p < 0.01 compared to controls), total cholesterol (-5.5%, p < 0.05), physical fitness (+37.2%, p < 0.01), and future risk for CAD (-7.9%, p < 0.01). Men and women responded differently to the program for all clinically-relevant variables, with men deriving greater benefit in terms of lipoprotein atherogenicity. Plasma lipid and lipoprotein responses to the lifestyle change program were not confounded by lipid-lowering medications.
  
  
  CONCLUSIONS
  In at risk patients motivated to participate, an intensive lifestyle change program can effectively alter traditional CAD risk factors and plasma lipoprotein subclasses and may reduce risk for cardiovascular events. Improvements in lipoprotein subclasses are more evident in men compared to women.
authors: Integrative Cardiac and Metabolic Health Program, Windber Research Institute, Windber, Pennsylvania, USA. d.decewicz@wriwindber.org
authors: David J
authors: DJ
authors: Decewicz
authors: David M
authors: DM
authors: Neatrour
authors: Amy
authors: A
authors: Burke
authors: Mary Jane
authors: MJ
authors: Haberkorn
authors: Heather L
authors: HL
authors: Patney
authors: Marina N
authors: MN
authors: Vernalis
authors: Darrell L
authors: DL
authors: Ellsworth
mesh_terms: D000924:Anticholesteremic Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D003324:Coronary Artery Disease / Q000097:blood* / Q000188:drug therapy; D005260:Female; D006801:Humans; D008019:Life Style; D008074:Lipoproteins / Q000097:blood* / Q000145:classification*; D008077:Lipoproteins, LDL / Q000097:blood; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D012307:Risk Factors; D012727:Sex Characteristics
chemical_list: D000924:Anticholesteremic Agents; D008074:Lipoproteins; D008077:Lipoproteins, LDL