LDL Particle Number and Risk of Future Cardiovascular Disease in the Framingham Offspring Study - Implications for LDL Management.
Level 3 - non-randomized controlled study
Prospective observational cohort study
PubMed 19657464 · doi:10.1016/j.jacl.2007.10.001
What was done
Researchers evaluated 3066 middle-aged white participants (53% women) free of cardiovascular disease (CVD) at baseline from the Framingham Offspring cohort. LDL cholesterol (LDL-C) and non-HDL cholesterol (non-HDL-C) were measured chemically, while LDL particle number (LDL-P) and VLDL particle number (VLDL-P) were quantified using nuclear magnetic resonance (NMR) spectroscopy. Participants were followed for a median of 14.8 years to assess incidence of first CVD events in multivariable models adjusting for non-lipid risk factors.
What was found
Over follow-up, 531 participants (265 men and 266 women) experienced a first CVD event. LDL-P had a stronger multivariable-adjusted relationship with future CVD than LDL-C or non-HDL-C in both sexes. Participants with low LDL-P (<25th percentile) had an event rate of 59 per 1000 person-years, compared to 81 per 1000 person-years for equivalently low LDL-C and 74 per 1000 person-years for low non-HDL-C.
Why it matters
This study demonstrates that LDL particle number may provide better cardiovascular risk discrimination than traditional cholesterol measures, especially at lower targets where particle composition varies.
Limits
The study population was restricted to middle-aged white adults, limiting generalizability to other racial and ethnic groups. Because this was an observational cohort, it cannot establish that targeting LDL-P reduction in clinical practice improves outcomes compared to standard LDL-C targets.
Cited by
- supports Data from the Multi-Ethnic Study of Atherosclerosis (MESA) and the Framingham Offspring study showed that LDL particle number (LDL-P) predicted cardiovascular disease risk better than LDL cholesterol (LDL-C).