Lipoprotein particle number and size predict vascular structure and function better than traditional lipids in adolescents and young adults

Abstract

Background In adults, dyslipidemia is associated with higher carotid thickness and arterial stiffness, predictors of CV events. In young subjects, lipid concentrations have not been consistently associated with vascular measures. Objective To compare nuclear magnetic resonance (NMR) measures of lipoprotein particle number (LDL-P, HDL-P, VLDL-P) and size (LDL-S, HDL-S, VLDL-S) to determine if they were associated with vascular measures more strongly than lipid concentrations (LDL-C, HDL-C, TG). Methods We evaluated 214 lean (L), 228 Obese (O) and 214 diabetic (T2DM) subjects age 10–24 years (33% male, 39% Caucasian). CV risk factors, vascular structure and arterial stiffness were measured. General linear models were constructed including demographics, risk factors and traditional or NMR lipid parameters. A composite vascular function score was developed as the outcome in receiver operator characteristic scores (ROC) for determining which lipid parameter was superior in predicting vascular damage. Results Risk factors worsened from L to O to T. However, LDL-C was similar in O and T while LDL-S differentiated the 3 groups (T>O>L, p≤0.0001). Models demonstrated the superiority of NMR values which entered for all but one vascular outcome and explained more of the variance than traditional lipid concentrations. ROC curves demonstrated that NMR values were superior in predicting vascular outcomes. Models stratified by race were similar but cut-points predicting vascular outcomes differed by race for TG, TG/HDL and VLDL. Conclusion Lipoprotein particle number and size are more strongly related to vascular structure and function than traditional lipid values. NMR lipid measures may be a better indicator of risk for target organ damage than traditional lipid measures in adolescents and young adults.

Dyslipidemia in Pediatric Type 2 Diabetes Mellitus

“…In the pediatric First Nation children study, in the presence of elevated TG, only 25% had an elevated LDL-C level compared with 37% with an elevated apo B level [32]. Conventional clinical screening and management of dyslipidemia with a traditional lipid profile may not be as sensitive to detail the overall atherogenic risk [37] and underestimate the severity of dyslipidemia in children and adolescents with T2D, detailed lipoprotein analysis including apo B measurements may be indicated in children and adolescents with T2D.…”

“…Lean, obese, and children with T2D are compared.Children with T2D had the largest number of the smallest and most dense LDL-C particles. [37] LDL-C low-density lipoprotein cholesterol, HDL-C high-density lipoprotien cholesterol, VLDL-C very low-density lipoprotein cholesterol, IR insulin resistance, T2D type 2 diabetes mellitus, T1D type 1 diabetes mellitus…”

Lipoprotein particles in patients with pediatric Cushing disease and possible cardiovascular risks

“…The small LDL particles are considered more atherogenic than the large LDL particles with previous studies showing that lower levels of LDL and HDL mean particle sizes are associated with insulin resistance [14, 15]. Two recent large scale studies in obese, pre-diabetic, and type 2 diabetic adolescents and young adults showed that NMR lipid profile is a better indicator of vascular damage compared to the traditional lipid profile [16, 17].…”

Target Organ Abnormalities in Pediatric Hypertension

“…Unfortunately, vascular TOD can be found in high-risk youth related to elevated cardiovascular risk factors. Higher cIMT is found in youth with obesity, 45 dyslipidemia, and clustering of cardiovascular risk factors. 46 Day et al performed a systematic review of over 300 articles to evaluate whether there was an independent relationship between blood pressure and cIMT in youth, and examined 28 of those studies that measured clinic blood pressure in detail.…”