Low-density lipoprotein and apolipoprotein B: clinical use in patients with coronary heart disease.
Managing low-density lipoprotein (LDL) is an integral part of clinical practice. What remains controversial is whether we are using the best measure of LDL quantity for this purpose. Historically, the cholesterol content of LDL particles (LDLC) has been used to express LDL quantity. However, because of variability in the cholesterol carried in LDL particles, frequent disagreement occurs between LDLC and particle measures of LDL quantity, including apolipoprotein B-100 (apo B) or nuclear magnetic resonance (NMR) LDL particle number (LDL-P). Studies consistently demonstrate apo B and LDL-P are superior predictors of coronary heart disease (CHD) risk and superior indicators of low CHD risk on lipid-lowering therapy. Recent recommendations advocate that, in addition to LDLC and non-high-density lipoprotein cholesterol, apo B (or NMR LDL-P) be used as a target of therapy. This article reviews the rationale supporting these recommendations and provides a model for integrating LDL particle measures in clinical practice.
Cromwell
William C
WC
Division of Atherosclerosis and Lipoprotein Disorders, Presbyterian Cardiovascular Institute, 125 Baldwin Avenue, Suite 200, Charlotte, NC 28204, USA. wcromwell@gmail.com
Barringer
Thomas A
TA
D000924:Anticholesteremic Agents / Q000627:therapeutic use; D001055:Apolipoproteins B / Q000097:blood / Q000187:drug effects*; D015415:Biomarkers; D003324:Coronary Artery Disease / Q000188:drug therapy / Q000517:prevention & control*; D006801:Humans; D006949:Hyperlipidemias / Q000517:prevention & control*; D008077:Lipoproteins, LDL / Q000097:blood / Q000187:drug effects*; D018570:Risk Assessment
D000924:Anticholesteremic Agents; D001055:Apolipoproteins B; D015415:Biomarkers; D008077:Lipoproteins, LDL