Refining lipoprotein assessment in diabetes: apolipoprotein B makes sense

To summarize the data that support the measurement of apolipoprotein B as an accurate reflection of low-density lipoprotein (LDL) particle number and an easily adapted parameter in clinical practice.

Study findings are reviewed and a flow chart is provided to guide lipid assessment in patients with dyslipidemia.

Current treatment guidelines for lipid management emphasize LDL cholesterol as the primary treatment target in patients at high risk of cardiovascular events. However, LDL cholesterol is a poor surrogate for LDL particle number, particularly in patients with altered LDL composition, such as those with insulin resistance, metabolic syndrome, and type 2 diabetes. Direct measurement of LDL particle number or size is not practical because of methodology and cost considerations. A suggested alternative target in patients with hypertriglyceridemia is non-high-density lipoprotein (HDL) cholesterol. Abundant evidence suggests that even non-HDL cholesterol is an inadequate approximation of the LDL particle number in such patients. The flow chart emphasizes the need to continue achieving the well-established LDL-cholesterol goal, while also considering apolipoprotein B measurement in those with hypertriglyceridemia, rather than relying on the less accurate surrogate of non-HDL cholesterol, when targeting therapy in such patients.

Presented evidence supports the measurement of apolipoprotein B as a more accurate reflection of LDL particle number than non-HDL cholesterol, and it is an easily adapted parameter in clinical practice.