Its been time that sub-classes of both LDL and HDL are there and some even market them.
Can you offer your comments on this style of testing of lipids/cholesterol or the traditional markers are suffice?
Hii Dr. Sikandar Hayat Khan Sir. I don't know much in deep about this topic.
Following expert's views.
By means of the “lipoprint method“ one can differentiate between atherogenic and non atherogenic LDL subfractions as shown in this article in
Neuroendocrinology Letters Volume 32 No. 3 2011:
Hyper-betalipoproteinemia LDL 1,2: A newly identified nonatherogenic hypercholesterolemia in a group of hypercholesterolemic subjects
Stanislav Oravec 1, Kristína Gruber 2, Elisabeth Dostal 3, Johannes Mikl 4
1 2nd Department of Internal Medicine, Faculty of Medicine, Comenius University, Bratislava, Slovakia 2 Department of Internal Medicine, Landesklinikum Thermenregion Baden, Austria
3 Krankenanstalten Dr. Dostal, Vienna, Austria
4 Department of Cardiology, Hietzing Hospital, Vienna, Austria
Correspondence to: Assoc. Prof. Stanislav Oravec, MD., PhD.
2nd Department of Internal Medicine, Faculty of Medicine, Comenius University,
Miczkiewiczova 13, 813 69 Bratislava, Slovakia.
tel: +421 2 57290 329; e-mail: [email protected]
Submitted: 2011-01-14 Accepted: 2011-04-05 Published online: 2011-06-29
Best regards, Günther
May be good for research purposes but not required and certainly not cost effective for routine patient management. All lipid guidelines are based primarily on LDL and non HDL values. It is enough if total cholesterol, TG and HDL are measured. One fifth of TH will give approximate VLDL values. Direct LDL can be measured when TG is high because Friediwald formula may not be reliable.
I agree with Dr Koshy. Not worth it. Adds little to practical treatment of dylsipidemia. Use the LDL- to HDL-cholestrol ratio as we have discussed in the past, remembering that LDL-cholesterol must always be below 170 mg/dl (when the precipitation method of HDL-cholesterol is used, but 160 mg/dl if the enzymatic method is used).
William Feeman I understand your focus on CRF. But this new data on lipids is emerging and sometimes we land into long list of tests.......moreover more stuff like these are invading clinical market and discussion forum like these helps shortlist our targets. I also feel most of this is not needed because we are quite limited in our interventional options like only having statins or fibrate like drugs. PCSK9 inhibitors are there but not much sure on that .......as they are new and time will test them.
The last heart attack in a non-smoking male patient of mine occurred about 9 years ago. The only women with heart attacks were cigarette smokers. The last paralytic stroke, regardless of sex, occurred in 2004. When you do it right, you don't need all of those fancy tests. Still it's a free country, so.....
This would be good for conducting research in this subject area. Performing this for patient care would not be a great idea as it would certainly be waste of time and energy for providing requisite benefit to patient
Contd. from previous answer.
For providing fast benefit to patient only certain basic parameters of lipid profile viz. cholesterol, HDL , LDL and VLDL Cholestero alongwith Triglycerides should useful.
.
I believe that just essential tests for lipid profile be done for dislipidemia. The same view has also been expressed by other scientists who have replied to this question.
In India, the following tests are performed under the head "lipid profile" in all sections of treatment of patients.
1.HDL
2. LDL
3.VLDL
4. Triglyceride
Then the risks are calculated by ratio of lipids.
Thanks.
Yes, but do we need any additions or deletions in the light of new emerging medicines. As in specific subcontinental population people with normal lipid profiles are suffering from hear diseases & strokes. So are we not missing something in regional and possibly other places?
I still feel that doing basic.tests like LDL- cholesterol and HDL cholesterol along With LDL/ HDL ratio would be more useful.
I would like to see a study on LDL subtypes in people with 'normal' or low LDL that still get vascular events. Also a study on LDL subtypes in people in teenage/early adulthood, to see if we can better predict future cardiovascular events: we really need better predictive tools.
Also: a study in smokers, to see the effect on LDL size.
I think its a useful test for study and to better understand the dynamics around LDL and vascular disease.
I think it might be a great future tool. We need to do some great studies first, though.
Dear Lalit Mohan Srivastava
I agree with you but don't you see many patients with ASCVD cases with normal HDL and LDL including their ratios?
The research identified small dense LDL particles to be more predictive of ASCVD, so why not them. We MUST be researching more to understand the patho-physiology and try to have more efficient biomarkers for ASCVD.
regards
Dear Dr. Sikander Hayat Khan
I agree with your views, that's why my views although applicable to most cases would not be conclusively universal and would require measurements of additional parameters. When and how depends on clinical observations.
Research activities are time consuming and money too, with out money we can conducted the activities, so any kind of work never think wastage of money. Always there is an output in any form success or failure.
Performing research work would certainly require money in the form of research Grant's for specific purposes and task and should not be considered as waste of money. Its requirement based.
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