Historically, LDL-C has been maintained as the primary therapeutic target in the prevention of atherosclerotic cardiovascular disease (ASCVD), with the goal of reducing its plasma concentration as much as possible. However, the prevalence of residual risk—even in patients with LDL-C levels within the optimal range—has compelled the scientific community to seek more precise biomarkers.
The Liposcale Test® addresses this need by offering advanced lipoprotein analysis based on Nuclear Magnetic Resonance (NMR) spectroscopy. NMR enables the direct determination of particle concentration (LDL-P), size (diameter), and lipoprotein composition. The reason these parameters are superior to LDL-C lies in the underlying physics of cholesterol transport and the atherogenic process.
The atherogenic potential of a lipoprotein is determined by its number, size, and composition. Each LDL particle contains a single molecule of Apolipoprotein B (ApoB), making the measurement of particle number (LDL-P) a more direct and precise indicator of the total number of atherogenic lipoproteins circulating in the blood. In contrast, LDL-C only measures the total amount of cholesterol contained within those particles, ignoring their total number.
In the context of atherogenic dyslipidemia (AD), common in diabetes mellitus (DM) and metabolic syndrome, LDL-P concentration may be clearly elevated even when LDL-C is normal or only mildly increased. This LDL-C:LDL-P discordance is crucial, as a normal LDL-C with a high particle number implies that these particles are predominantly small and dense LDL (sdLDL).
sdLDL particles have high atherogenic potential for several reasons:
Large-scale epidemiological studies have shown that LDL-P better predicts cardiovascular events than LDL-C. For example, in the Framingham Offspring Study, LDL-P concentration proved to be a more sensitive indicator of cardiovascular disease (CVD) risk. Furthermore, NMR subclass analysis has shown that medium-sized LDL particles are positively associated with cardiovascular, coronary, and cerebrovascular events.
The Liposcale® test allows clinicians to identify atherogenic dyslipidemia in high-risk populations such as those with diabetes, obesity, metabolic syndrome, or hypertriglyceridemia. By quantifying LDL-P and determining whether the profile is skewed toward a predominance of small, dense LDL particles, the test helps avoid underestimation of cardiovascular risk (CVR). This is crucial for therapeutic decision-making and prevention strategies, even when LDL-C is at target levels.
In fact, increased LDL-P has been associated with myocardial infarction, ischemic stroke, and peripheral arterial disease. Evidence suggests that therapeutic monitoring based on LDL-P allows for better assessment of residual risk.
