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Increasing the complexity of lipoprotein characterization for cardiovascular risk in type 2 diabetes

Montse Guardiola1,2,3, Pere Rehues1,2,3, Núria Amigó2,3,4,5

  • 1Departament de Medicina i Cirurgia, Unitat de Recerca en Lípids i Arteriosclerosi (URLA), Universitat Rovira i Virgili, Reus, Spain.

European Journal of Clinical Investigation
|April 13, 2024
PubMed

Insights

Cardiovascular disease risk in diabetes is high, even with normal LDL cholesterol. Understanding lipoprotein changes offers new insights into this hidden risk.

Area of Science:

  • Cardiovascular Medicine
  • Metabolic Disorders
  • Lipidology

Background:

  • Individuals with type 2 diabetes mellitus (T2DM) face a high burden of cardiovascular disease, irrespective of LDL cholesterol levels.
  • Persistent atherogenic dyslipidemia, including elevated triglycerides, remnant cholesterol, smaller LDL particles, and reduced HDL cholesterol, contributes to arterial cholesterol accumulation in T2DM.
  • The complex interplay between dyslipidemia and atherosclerosis in T2DM necessitates a deeper investigation into lipoprotein composition and functionality.

Purpose of the Study:

  • To explore the multifaceted nature of lipoprotein characterization in understanding the hidden cardiovascular risk associated with T2DM.
  • To review three distinct levels of lipoprotein analysis, from routine clinical biochemistry to advanced profiling and minor component identification.
  • To emphasize the importance of integrating comprehensive lipoprotein data into population studies for ASCVD in T2DM.

Main Methods:

  • Review of existing literature on lipoprotein characterization and cardiovascular risk in diabetes.
  • Discussion of routine clinical biochemistry parameters relevant to lipid metabolism.
  • Exploration of advanced nuclear magnetic resonance (NMR)-based lipoprotein profiling techniques.
  • Examination of minor lipoprotein components and physical properties influencing arterial cholesterol deposition.

Main Results:

  • Routine clinical biochemistry provides foundational lipid information but may not fully capture atherogenic risk in T2DM.
  • Advanced NMR profiling offers detailed insights into lipoprotein particle size, number, and composition.
  • Identification of specific lipoprotein subclasses and properties can elucidate cholesterol accumulation mechanisms in individuals with normal LDLc.

Conclusions:

  • A comprehensive understanding of lipoprotein behavior, encompassing routine, advanced, and detailed analyses, is crucial for managing cardiovascular risk in T2DM.
  • Integrating multi-layered lipoprotein data into population studies is essential for accurately assessing ASCVD risk in diabetic populations.
  • Biotechnological advancements are needed to facilitate large-scale, methodologically diverse lipoprotein parameter determination for widespread clinical application.

Keywords:
LPSNMRapoC‐IIIcardiovascular riskdiabeteslipoprotein

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