Methods of CVD assessment: traditional vs novel
Traditional tests for CVD risk assessment only detect approx. 20% of all CVD patients. The other 80% can be identified by differentiating subgroups, and carrying out more detailed lipid testing.
Measuring HDL and LDL Subclasses
HDL comprises of several subclasses which differ in their sizes, densities and components; and are considered to play different roles in arteriosclerosis. Elevated levels of HDL3 reflect abnormally increased triglyceride content of HDL, which renders its protection factor almost useless.
Small-dense LDL (sLDL) is a subtype of LDL. Research has shown those with a predominance of sLDL have a 3-fold increased risk of myocardial infarction (MI). Elevated levels of sLDL are caused by sedentary lifestyle, high saturated fat intake, insulin resistance and genetics.
Measuring the Extended Lipid Profile
Levels of Lp(a) associate robustly and specifically with increased CVD risk. The European Guidelines for Management of Dyslipidaemia incorporated clinical recommendations for Lp(a), with its measurement indicated for those with a strong family history of premature CVD.
Additionally, studies have shown an increasing relationship between Apolipoproteins (Apos) and CVD:
- There is an inverse relationship between Apo A-I and CVD, but Apo B has a direct relationship with it
- Increased production of Apo A-II also promotes atherosclerosis by decreasing the proportion of HDL containing Apo A-I
- Apo C-II deficiency can lead to hypertriglyceridemia in patients; therefore its measurement can be used as an aid in assessing CVD risk
- Elevated levels of Apo C-III are associated with primary and secondary hypertriglyceridemia, and therefore CVD. Factors that can influence Apo C-III levels include gender, age, menopause and genetics
- A deficiency in Apo E raises serum cholesterol and triglyceride levels and as a result, leads to premature atherosclerosis. Factors affecting Apo E concentrations include genetics, oral contraceptive intake, puberty, BMI and age
Cardiac health and regular cardiovascular screening enables risk factors to be detected in their earliest stages. Further examination of HDL and LDL subclasses and extended lipid profile have never been more important, as they can aid a better risk prediction and as such identify the necessary tools to prevent and reduce risk.
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