MDLinxLipid Panels Lie: ‘It’s Time to Rethink the Way We Evaluate CV Risk—Before It’s Too Late’

This article discusses limitations of standard lipid panels for cardiovascular risk assessment, highlighting the potential clinical value of advanced markers like LDL particle number (LDL-P) and apolipoprotein B (ApoB). The content represents expert opinion rather than new research, citing observations from clinical practice about patients with discordant LDL-C and LDL-P values who may be misclassified using traditional testing alone.

Key Clinical Considerations

• Evidence for discordance: Patients with “normal” LDL-C levels may still harbor elevated cardiovascular risk due to high LDL particle numbers, creating a risk assessment gap in current practice.
• Alternative biomarkers: ApoB and LDL-P are presented as potentially superior predictors of cardiovascular risk compared to standard lipid measurements like LDL-C.
• High-risk populations: The article identifies specific patient groups who may benefit most from advanced testing: those with metabolic syndrome, family history of premature ASCVD, or unexplained risk profiles.
• Lipoprotein(a) testing: Lp(a) is highlighted as a strong genetic risk factor for atherosclerosis that remains absent from standard lipid panels despite its clinical significance.
• Implementation gap: While making a case for advanced testing, the article acknowledges these markers are not yet mainstream in clinical practice, suggesting advocacy is needed.

Clinical Practice Impact

• Patient risk stratification: Consider advanced lipid testing for patients with risk factors but “normal” traditional lipid panels, especially those with metabolic syndrome or family history of premature CVD.
• Communication strategy: When explaining cardiovascular risk to patients, distinguish between cholesterol concentration (LDL-C) and particle number (LDL-P) to provide more complete risk information.
• Test selection guidance: Order ApoB or LDL-P testing selectively based on clinical suspicion of discordance, not universally, to optimize resource utilization.
• Guideline awareness: Note that although these markers show promise, current guidelines still primarily recommend standard lipid panels, requiring clinical judgment when ordering advanced tests.

More on Lipid Health