title: HDL size is more accurate than HDL cholesterol to predict carotid subclinical atherosclerosis in individuals classified as low cardiovascular risk.
abstract: Misclassification of patients as low cardiovascular risk (LCR) remains a major concern and challenges the efficacy of traditional risk markers. Due to its strong association with cholesterol acceptor capacity, high-density lipoprotein (HDL) size has been appointed as a potential risk marker. Hence, we investigate whether HDL size improves the predictive value of HDL-cholesterol in the identification of carotid atherosclerotic burden in individuals stratified to be at LCR.
  
  
  
  284 individuals (40-75 years) classified as LCR by the current US guidelines were selected in a three-step procedure from primary care centers of the cities of Campinas and Americana, SP, Brazil. Apolipoprotein B-containing lipoproteins were precipitated by polyethylene glycol and HDL size was measured by dynamic light scattering (DLS) technique. Participants were classified in tertiles of HDL size (<7.57; 7.57-8.22; >8.22 nm). Carotid intima-media thickness (cIMT) <0.90 mm (80th percentile) was determined by high resolution ultrasonography and multivariate ordinal regression models were used to assess the association between cIMT across HDL size and levels of lipid parameters. HDL-cholesterol was not associated with cIMT. In contrast, HDL size >8.22 nm was independently associated with low cIMT in either unadjusted and adjusted models for age, gender and Homeostasis Model Assessment 2 index for insulin sensitivity, ethnicity and body mass index (Odds ratio 0.23; 95% confidence interval 0.07-0.74, p = 0.013).
  
  
  
  The mean HDL size estimated with DLS constitutes a better predictor for subclinical carotid atherosclerosis than the conventional measurements of plasma HDL-cholesterol in individuals classified as LCR.
authors.affiliation: Department of Cardiology, Faculty of Medical Sciences, University of Campinas, Campinas, SP, Brazil; Department of Clinical Pathology, Lipid Laboratory and Center for Medicine and Experimental Surgery, Faculty of Medical Sciences, University of Campinas, Campinas, SP, Brazil.
authors.forename: Eliane Soler
authors.initials: ES
authors.lastname: Parra
authors.affiliation: Department of Cardiology, Faculty of Medical Sciences, University of Campinas, Campinas, SP, Brazil; Department of Clinical Pathology, Lipid Laboratory and Center for Medicine and Experimental Surgery, Faculty of Medical Sciences, University of Campinas, Campinas, SP, Brazil.
authors.forename: Natalia Baratella
authors.initials: NB
authors.lastname: Panzoldo
authors.affiliation: Department of Clinical Pathology, Lipid Laboratory and Center for Medicine and Experimental Surgery, Faculty of Medical Sciences, University of Campinas, Campinas, SP, Brazil.
authors.forename: Vanessa Helena de Souza
authors.initials: VH
authors.lastname: Zago
authors.affiliation: Department of Clinical Pathology, Lipid Laboratory and Center for Medicine and Experimental Surgery, Faculty of Medical Sciences, University of Campinas, Campinas, SP, Brazil.
authors.forename: Daniel Zanetti
authors.initials: DZ
authors.lastname: Scherrer
authors.affiliation: Department of Clinical Pathology, Lipid Laboratory and Center for Medicine and Experimental Surgery, Faculty of Medical Sciences, University of Campinas, Campinas, SP, Brazil.
authors.forename: Fernanda
authors.initials: F
authors.lastname: Alexandre
authors.affiliation: Department of Clinical Pathology, Lipid Laboratory and Center for Medicine and Experimental Surgery, Faculty of Medical Sciences, University of Campinas, Campinas, SP, Brazil.
authors.forename: Jamal
authors.initials: J
authors.lastname: Bakkarat
authors.affiliation: Lipid Laboratory, Faculty of Medical Sciences, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Valeria Sutti
authors.initials: VS
authors.lastname: Nunes
authors.affiliation: Lipid Laboratory, Faculty of Medical Sciences, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Edna Regina
authors.initials: ER
authors.lastname: Nakandakare
authors.affiliation: Lipid Laboratory, Faculty of Medical Sciences, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Eder Carlos Rocha
authors.initials: EC
authors.lastname: Quintão
authors.affiliation: Department of Cardiology, Faculty of Medical Sciences, University of Campinas, Campinas, SP, Brazil.
authors.forename: Wilson
authors.initials: W
authors.lastname: Nadruz
authors.affiliation: Department of Clinical Pathology, Lipid Laboratory and Center for Medicine and Experimental Surgery, Faculty of Medical Sciences, University of Campinas, Campinas, SP, Brazil.
authors.forename: Eliana Cotta
authors.initials: EC
authors.lastname: de Faria
authors.affiliation: Department of Cardiology, Faculty of Medical Sciences, University of Campinas, Campinas, SP, Brazil.
authors.forename: Andrei C
authors.initials: AC
authors.lastname: Sposito
mesh_terms: D000328:Adult; D000368:Aged; D058070:Asymptomatic Diseases; D050197:Atherosclerosis / Q000097:blood* / Q000175:diagnosis; D002340:Carotid Artery Diseases / Q000097:blood* / Q000175:diagnosis; D008076:Cholesterol, HDL / Q000097:blood* / Q000737:chemistry; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010316:Particle Size; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D008076:Cholesterol, HDL