Conventional Lipid Panel
The conventional lipid panel:
- Cholesterol ~ Is an alcohol-sterol and is used by the body in the production of hormones and bile acids for cell membranes.
- Triglycerides ~ Are blood fats or esters of glycol, and like cholesterol are vital sources of energy for the body.
- HDL ~ High Density Lipoprotein Cholesterol: is an indicator of how well the body utilizes fats
- LDL ~ Low Density Lipoprotein Cholesterol: is an indicator of a patient’s risk for atherosclerosis.
More to the story
However… it’s really the size of the lipid particles that matters. To really assess for risk of heart attack or stroke a Lipoprotein Particle Test would reveal more information.
There are five major subgroups of Low Density Lipoproteins (LDL): IDL (intermediate density lipoprotein), I, II, III and IV. IDL is the largest, least dense and most buoyant, while LDL-IV is the smallest and most dense. LDL particles that are small are also dense and these terms are often used interchangeably. The smaller the LDL particle, the more dangerous it is. In fact, small dense LDL (LDLI-II and LDL-IV) is three times more atherogenic than buoyant LDL.
According to the National Cholesterol Education Program (NCEP), only about half of the variability in coronary heart disease risk can be attributed to conventional risk factors (i.e. LDL, HDL and triglyceride levels). Other, more specific risk factors, enhance predictive power of cardiovascular disease in individuals. Small – dense LDL is one of these specific risk factors that may be independent of other lipid-related risk factors. Lipoproteins transport cholesterol throughout the body. But it is the actual lipoprotein particle, not the cholesterol within them, that penetrates the arterial wall and causes heart disease. That is why it is necessary to know the number of small LDL particles.
Why is small-dense LDL so harmful?
Smaller particles of LDL can more easily penetrate the arterial wall than large LDL particles simply due to their size. Therefore, the smaller the LDL particle, the more likely it is to enter the arterial endothelium, where it becomes oxidized, is taken up by a macrophage cell which then becomes a foam cell, which eventually stick together to build plaque within the arteries. Evidence also suggests that small-dense LDL is associated with vascular dementia.
It is also important to know how many LDL particles are present, in addition to their size. Just as small LDL particles can fit through the arterial lining more easily than large LDL particles, the more LDL particles there are, the more likely they will enter the arterial intima, regardless of size. It is therefore imperative to measure both the size (density) and number of LDL particles.
NEW RISK FACTORS:
- Small, dense LDL: these atherogenic particles are easily oxidized and penetrate the arterial endothelium to form plaque
- Lp(a): this small, dense LDL is involved in thrombosis
- RLP (Remnant Lipoprotein): is very atherogenic, has a similar composition and density of plaque, is believed to be a building block of plaque and does not need to be oxidized like other LDL particles
- HDL2b: positively correlates with heart health because it is an indicator of how well excess lipids are removed