Cited by 163Lipoproteins and Cardiovascular HealthDiabetes, Cardiovascular Risks, and LipoproteinsCholesterol and Lipid Metabolism

Systematic review: association of low-density lipoprotein subfractions with cardiovascular outcomes.

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Ip, Stanley, Lichtenstein, Alice H., Chung, Mei, Lau, Joseph, Balk, Ethan M.·2009·Annals of Internal Medicine

Abstract

BACKGROUND: Measures of low-density lipoprotein (LDL) subfractions have been proposed as an independent risk factor for cardiovascular disease. PURPOSE: To review published studies that reported relationships between LDL subfractions and cardiovascular outcomes. DATA SOURCES: MEDLINE (1950 to 5 January 2009), CAB Abstracts (1973 to 30 June 2008), and Cochrane Central Register of Controlled Trials (2nd quarter of 2008), limited to English-language studies. STUDY SELECTION: 3 reviewers selected longitudinal studies with 10 or more participants that reported an association between LDL subfractions and incidence or severity of cardiovascular disease and in which plasma samples were collected before outcome determination. DATA EXTRACTION: Data were extracted from 24 studies. The 10 studies that used analytical methods available for clinical use (all of which used nuclear magnetic resonance) had full data extraction, including quality assessment (good, fair, or poor). All studies were extracted by 1 researcher and verified by another. DATA SYNTHESIS: All 24 studies, and the subset of 10 nuclear magnetic resonance studies, were heterogeneous in terms of the specific tests analyzed, analytical methods used, participants investigated, and outcomes measured. Higher LDL particle number was consistently associated with increased risk for cardiovascular disease, independent of other lipid measurements. Other LDL subfractions were generally not associated with cardiovascular disease after adjustment for cholesterol concentrations. No study evaluated the incremental value of LDL subfractions beyond traditional cardiovascular risk factors or their test performance. LIMITATION: Publication bias was a possibility. CONCLUSION: Higher LDL particle number has been associated with cardiovascular disease incidence, but studies have not determined whether any measures of LDL subfractions add incremental benefit to traditional risk factor assessment. Routine use of clinically available LDL subfraction tests to estimate cardiovascular disease risk is premature.

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  • Neither LDL size nor the concentration of small, dense LDL particles adds to CVD prediction in multiple variable analysis beyond standard lipid risk factors, although small LDL particles predict cardiovascular risk in univariate analysis.

    “Neither LDL size nor the concentration of small, dense LDL particles adds to CVD prediction in multiple variable analysis beyond the standard lipid risk factors, although small LDL particles predict cardiovascular risk in univariate analysis (35)(36)(37).”

    From Evaluation and Treatment of Hypertriglyceridemia: An Endocrine Society Clinical Practice Guideline (2012) · cites this paper as [37]

    The Results sections report associations between LDL subfractions and cardiovascular outcomes in many unadjusted analyses, but no association for LDL size or small-particle concentration in the specified lipid-adjusted analyses of incident events. The claim overstates the conclusion about added predictive value: the Discussion says no study adequately tested whether LDL subfraction measurements improve prediction beyond traditional risk factors. Page numbers are unavailable in our copy. (LLM, conf=0.88)

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  • An increased number of atherogenic particles may adversely influence CVD risk.

    “Experimental studies suggest that hypertriglyceridemic HDL may be dysfunctional, 55,56 that small, dense LDL particles may be more susceptible to oxidative modification, 57,58 and that an increased number of atherogenic particles may adversely influence CVD risk 59 ; however, no clinical outcome trials to date have determined whether normalization of particle composition or reduction of particle”

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Authors
Ip, S., Lichtenstein, A. H., Chung, M., Lau, J., & Balk, E. M.
Affiliations
Tufts University (US)
Corresponding author
Ip, Stanley
Venue
Annals of Internal Medicine
Published
2009-04-07
Volume
150
Issue
7
Pages
474-484
ISSN
  • 0003-4819 (ISSN-L)
  • 1539-3704
OpenAlex
W2048908649
Cited by
163
References
44
Citations by year
2026: 5 · 2025: 4 · 2024: 3 · 2023: 9 · 2022: 10 · 2021: 13 · 2020: 4 · 2019: 9 · 2018: 10 · 2017: 10 · 2016: 7 · 2015: 9 · 2014: 8 · 2013: 14 · 2012: 15
FWCI
2.56
Type
journal article
Language
en
Open access
Locations
  • Annals of Internal Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • U.S. Public Health Service (290-020022)
  • National Heart, Lung, and Blood Institute (R01HL054727, R01HL074388)
Topics
  • Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Health Sciences › Medicine › Surgery › Cholesterol and Lipid Metabolism
Keywords
low-density lipoprotein subfractions, LDL particle number, cardiovascular risk, cardiovascular outcomes, cardiovascular risk assessment, LDL cholesterol, lipoprotein particle size
MeSH terms
Cardiovascular Diseases, Humans, Lipoproteins, LDL, Risk Factors, Incidence, Disease Progression, Nuclear Magnetic Resonance, Biomolecular

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