Body |
As the author of this particular blog, I'd like to know "Is LDL or HDL subfractionation requested by your clinicians?"
At our institution, we receive few (if any) requests for LDL or HDL subfractionation over the course of a year. The issues here concerning LDL subfractionation are lack of reproducible classification of subfractionation when comparing methods [1], lack of available drugs that selectively lower dense LDL levels, and lack of outcome studies that show lowering dense LDL specifically lowers risk for CVD independent of lowering other LDL subfractions. As well, dense LDL is most commonly elevated in the setting of the metabolic syndrome where pharmacotherapy, if indicated, would most likely be targeting elevations in VLDL (e.g., elevated triglycerides) and depressions in HDL-C. Fortunately, those drugs used to lower VLDL also lower LDL.
[1] Ensign W, Hill N, Heward CB. Disparate LDL phenotypic classification among 4 different methods assessing LDL particle characteristics. Clin Chem. 2006 Sep;52(9):1722-7.
|