Key result
The small dense LDL phenotype in familial combined hyperlipidemia was associated with a 10-times higher number of VLDL1 particles and increased plasma insulin compared to the buoyant LDL phenotype.
Observational (n=72)
In familial combined hyperlipidemia, the small dense LDL phenotype is associated with a distinct hypertriglyceridemic profile and increased VLDL1 particles, highlighting the role of the VLDL triglyceride metabolic pathway.
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Pattern B LDL links to VLDL1 excess in familial combined hyperlipidemia; hypothesis-generating and should not yet change practice.
OBJECTIVE: The present study addresses the presence of distinct metabolic phenotypes in familial combined hyperlipidemia (FCHL) in relation to small dense low-density lipoprotein (sd LDL) and very low-density lipoprotein (VLDL) subclasses. METHODS AND RESULTS: Hyperlipidemic FCHL relatives (n=72) were analyzed for LDL size by gradient gel electrophoresis. Pattern B LDL (sd LDL, particle size <258 A) and pattern A LDL (buoyant LDL, particle size > or =258 A) were defined. Analyses showed bimodal distribution of LDL size associated with distinct phenotypes. Subjects with predominantly large, buoyant LDL showed a hypercholesterolemic phenotype and the highest apo B levels. Subjects with predominantly sd LDL showed a hypertriglyceridemic, low high-density lipoprotein (HDL) cholesterol phenotype, with moderately elevated apoB, total cholesterol level, and LDL cholesterol level. Subjects with both buoyant LDL and sd LDL (pattern AB, n=7) showed an intermediate phenotype, with high normal plasma triglycerides. VLDL subfraction analysis showed that the sd LDL phenotype was associated with a 10-times higher number of VLDL1 particles of relatively lower apo AI and apo E content, as well as smaller VLDL2 particles, in combination with increased plasma insulin concentration in comparison to pattern A. CONCLUSIONS: The present observations underscore the importance of the VLDL triglyceride metabolic pathway in FCHL as an important determinant of the phenotypic heterogeneity of the disorder.
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Georgieva et al. (2004) conducted an observational in Familial Combined Hyperlipidemia (n=72). Small dense LDL (Pattern B) vs. Buoyant LDL (Pattern A) was evaluated on Metabolic phenotypes and VLDL subfraction characteristics. The small dense LDL phenotype in familial combined hyperlipidemia was associated with a 10-times higher number of VLDL1 particles and increased plasma insulin compared to the buoyant LDL phenotype.
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