Clinical Implications of Discordance between

Low-Density Lipoprotein Cholesterol and Particle

Number
James D. Otvos, Samia Mora, Irina Shalaurova, Philip Greenland, Rachel H.
Mackey, David C. Goff

Objective
To examine the differences between concordant and discordant levels of LDL-C
and LDL-P as they relate prospectively to incident cardiovascular disease (CVD)
events in a diverse population from the Multi-Ethnic Study of Atherosclerosis
(MESA).
Research Design and Methods
This paper reports on an analysis of data from a prospective, observational study
of 5598 ethnically diverse men and women free of self-reported cardiovascular
disease who were evaluated for diabetes and metabolic syndrome, and were
followed for incident CVD events over a mean of 5.5 years. For this study, CVD
events include myocardial infarction, coronary heart disease, death, angina,
stroke, stroke death, or other CVD death. A total of 319 CVD events were
reported in the population studied.
A secondary investigation was conducted to examine the relationship of LDL-C
and LDL-P to cross-sectional carotid IMT results. In this cross sectional analysis,
4499 participants from the original cohort qualified as they were not on lipid
lowering medications at baseline and had complete data.
Results
This analysis confirms in a large multiethnic cohort that the disagreement of LDLC and LDL-P levels, due to the wide variability of the cholesterol content of LDL
particles, has clinical relevance. The consequence of this variability is that LDLC levels can either over-represent or under-represent the concentration of LDL-P
and the LDL-related risk of atherosclerosis and future cardiovascular events in
many people. It is plausible that elevated LDL particle concentrations might
identify in a more straightforward manner those patients likely to benefit from
more optimal LDL-lowering treatment.
Conclusions
When LDL-P and LDL-C were discordant, LDL-P was more strongly associated
with the risk of CVD events and with atherosclerosis as measured by carotid IMT
than was LDL-C. This finding has potentially important implications regarding our
understanding of the etiology of atherosclerotic cardiovascular disease.
Journal of Clinical Lipidology, 2011;5(2);105-113