Moving beyond LDL-C: incorporating lipoprotein particle numbers and geometric parameters to improve clinical outcomes

Lipoproteins are complex protein-enwrapped particles which traffic hydrophobic lipids and other molecules between tissues in plasma. Under a variety of pathological states, specific lipoproteins trafficking sterols, phospholipids, and fatty acids enter arterial walls enhancing a maladaptive inflammatory response resulting in atherogenesis. Several lipoprotein particle geometric parameters are now readily available from the laboratory. Such measurements beyond standard lipid concentrations can be used to better understand both the link between atherogenesis and the trafficking patterns of lipoproteins. Often, the various laboratory indices, especially standard particle lipid concentrations versus lipoprotein particle parameters, seem to conflict or exhibit discordance and thus confuse the patient and the provider. By using readily available (but often misunderstood) particle geometric parameters from two patients, we have attempted to illustrate that by properly utilizing the newer assays, very discordant standard lipid concentrations and lipoprotein laboratory parameters can be present in two specific patients and demonstrate how the newer parameters can aid the clinicians in performing better risk assessment and treatment decisions.