Dyslipidemias

New Paths

Cardiovascular Disease

• Cardiovascular disease is the leading cause of death in Portugal.
• It accounts for about 40% of all deaths in the country.
• The World Health Organization predicts that cardiovascular diseases will continue to rise through 2020.

Lipids and lipoproteins are strongly associated with cardiovascular diseases, particularly acute coronary syndrome.

What are lipoproteins?

Lipids (cholesterol, triglycerides, and phospholipids) do not circulate freely in plasma. They are transported in particles called lipoproteins.

Lipoproteins vary in size, density, and chemical composition.

There are 5 classes of lipoproteins:

• Chylomicrons
• VLDL (very low-density lipoprotein)
• IDL (intermediate-density lipoprotein)
• LDL (low-density lipoprotein)
• HDL (high-density lipoprotein)

Composition of LDL

• LDL subclasses 1 and 2 (larger and less dense) are non-atherogenic LDL. They are responsible for transporting cholesterol throughout the body.
• LDL subclasses 3 through 7 (small and dense) are atherogenic LDL. They are easily oxidized and contribute to cardiovascular disease.
• Normal LDL levels are not always indicative of low cardiovascular risk.
• The presence of subclasses 3 through 7 is associated with a threefold increased risk of cardiovascular events, even with normal LDL levels.

Polyacrylamide gel lipoprotein electrophoresis (PAGLE)

Identifies up to 12 lipoprotein bands that are separated according to their size.

(1 VLDL, 3 IDLs, 7 LDLs, and 1 HDL)

Benefits of the PLGE profile

• The only FDA-approved diagnostic test for the separation and quantification of LDL-C subfractions.
• Quantifies cholesterol (mg/dL) in up to 12 lipoprotein fractions and subfractions.
• VLDL—associated with hypertriglyceridemia.
• Mid A, B, and C (remaining IDL and VLDL). Increased risk of cardiovascular disease.
• LDL 1 and 2—associated with hypercholesterolemia.
• LDL 3 through 7—associated with a threefold increase in cardiovascular disease.
• HDL—Cholesterol levels below <40 mg/dL in men and <50 mg/dL in women are a cardiovascular risk factor.

_{Example 1: Type A lipoprotein profile with no atherogenic subfractions, despite elevated TC and LDL-C.}

_{Example 2: Non-A-type lipoprotein profile, with atherogenic LDL subfractions 3, 4, 5, and 6, despite low total cholesterol (TC) and LDL-C levels.}

The ELGP allows for the selection of individualized therapies

Different profiles require different treatments

• Statins reduce total cholesterol levels and the number of lipoprotein particles.
• Niacin and fibrates alter the distribution of particles: from small and dense to larger and less atherogenic.
• Combination therapy

ELGP allows for monitoring the long-term effectiveness of therapy

_{Before treatment}

_{After treatment}

Polyacrylamide gel lipoprotein electrophoresis (ELGP)

It should be used and valued:

• In the study of dyslipidemia associated with diabetes,
• In the study of metabolic syndrome,
• In coronary artery disease,
• In patients with a family history of dyslipidemia,
• In patients with a high coronary calcium score on imaging,
• In monitoring lipid-lowering therapy, to assess the efficacy of statin therapy and whether or not to add fibrates or niacin plus laropiprant.

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