Update on the laboratory investigation of dyslipidemias

Area of Science:

• Clinical Chemistry
• Cardiovascular Medicine
• Biomarker Discovery

Background:

• Traditional LDL-cholesterol (LDL-C) measurements have limitations in accurately assessing cardiovascular disease (CVD) risk.
• Emerging evidence suggests lipoprotein particle size and concentration, as well as HDL function, may offer superior CVD risk prediction.
• Current laboratory methods for these novel markers lack standardization and validation for widespread clinical use.

Purpose of the Study:

• To review the limitations of current laboratory technologies for CVD risk assessment.
• To explore the evidence supporting emergent biomarkers, including lipoprotein subclasses and HDL function, for improved CVD risk prediction.
• To highlight the need for robust analytical methods for novel CVD risk markers.

Main Methods:

• Review of existing literature on laboratory methods for CVD risk assessment.
• Analysis of studies investigating lipoprotein particle concentration (e.g., NMR, ion mobility) and HDL function assays.
• Discussion of alternative lipid measurements like non-HDL-C and apolipoprotein B.

Main Results:

• Established methods like Friedewald calculation for LDL-C have significant limitations.
• Lipoprotein particle concentration and HDL function assays show potential as alternative CVD risk predictors.
• Apolipoprotein B may offer a more accurate reflection of LDL particle numbers than LDL-C.
• Non-fasting lipid measurements and early diagnosis of genetic dyslipidemias present practical advantages.

Conclusions:

• There is a need for validated, robust analytical methods for lipoprotein subclasses and HDL function assays.
• Novel biomarkers and genetic factors (ApoCIII, lipoprotein (a)) may enhance CVD risk assessment, especially in familial dyslipidemias.
• Clinical laboratories must evolve to incorporate advanced diagnostics for more effective CVD risk stratification and personalized therapy.