Traditional and Novel Markers: Target of Treatment vs Marker of Risk

Area of Science:

• Cardiovascular Medicine
• Lipidology
• Preventive Cardiology

Background:

• Low-density lipoprotein cholesterol (LDL-C) is a primary marker for cardiovascular (CV) risk, directly correlating with atherosclerotic disease.
• Traditional CV risk assessment often relies on LDL-C, typically estimated by the Friedewald equation, which may not capture the complete risk profile.
• Emerging evidence highlights the importance of other lipid markers beyond LDL-C.

Purpose of the Study:

• To discuss lipid-related markers associated with cardiovascular risk.
• To emphasize the significance of non-high-density lipoprotein cholesterol and apolipoprotein B100 alongside LDL-C.
• To underscore the need for incorporating triglycerides (TGs) and lipoprotein(a) [Lp(a)] into comprehensive CV risk assessments.

Main Methods:

• Review and discussion of current literature on lipid markers and CV risk.
• Analysis of the limitations of LDL-C estimation using the Friedewald equation.
• Examination of the roles of triglycerides (TGs) and lipoprotein(a) [Lp(a)] in CV disease.

Main Results:

• Elevated TGs may indicate increased cholesterol in non-LDL particles, suggesting non-high-density lipoprotein cholesterol or apolipoprotein B100 are more accurate risk indicators.
• Lipoprotein(a) [Lp(a)], a genetically determined LDL-like particle, possesses inflammatory and prothrombotic properties contributing to CV risk.
• Novel therapies targeting Lp(a) are emerging, but their clinical benefit in preventing CV outcomes requires further validation.

Conclusions:

• While LDL-C remains important, its limitations necessitate a broader assessment.
• Triglycerides (TGs) and lipoprotein(a) [Lp(a)] are crucial emerging markers for a more accurate and comprehensive cardiovascular risk evaluation.
• Healthcare professionals should re-evaluate traditional lipid assessment strategies to include TGs and Lp(a).