Atherogenic dyslipidemia (AD) is a complex metabolic condition that is highly prevalent in individuals with obesity, metabolic syndrome, and type 2 diabetes. It is characterized by a specific imbalance: elevated triglyceride (TG) levels, low concentrations of HDL cholesterol (HDL-C), and a qualitative increase in LDL particles, which become smaller and denser (sdLDL). The most insidious aspect of this pattern is that LDL cholesterol (LDL-C) often appears at normal or only slightly elevated levels, leading to a systematic underestimation of cardiovascular risk when only conventional biochemical tests are used.
Pathophysiological driver: insulin resistance
The pathophysiological driver of atherogenic dyslipidemia (AD) is insulin resistance. Loss of insulin sensitivity in adipose tissue increases the flux of fatty acids to the liver, which stimulates the overproduction of large VLDL particles. These particles interact with cholesteryl ester transfer protein (CETP), which exchanges triglycerides from VLDL for cholesterol from LDL and HDL. The result is triglyceride-rich LDL and HDL particles, which are subsequently hydrolyzed by hepatic lipase, reducing their size and increasing their density.
Implications for vascular health
1-sdLDL: Smaller LDL particles penetrate the endothelium more easily and have a greater affinity for intimal proteoglycans, increasing their retention time and susceptibility to oxidation.
2-Discordance: In atherogenic dyslipidemia (AD), the number of LDL particles (LDL-P) is often disproportionately elevated relative to cholesterol mass (LDL-C). LDL-P has been shown to be a better predictor of cardiovascular events than LDL-C in patients with this metabolic profile.
3-Subclinical Inflammation: AD is not only a lipid disorder; it is a chronic low-grade inflammatory state that contributes to vascular complications.
Liposcale®: advanced analysis of atherogenic dyslipidemia (AD)
The Liposcale® test is an ideal tool for characterizing atherogenic dyslipidemia (AD). By using 2D diffusion NMR, Liposcale® can decompose the lipid spectrum and accurately quantify the number of particles in each subclass (large, medium, and small). This information allows clinicians to identify “hidden” pro-atherogenic patterns and make personalized therapeutic decisions, such as adopting more aggressive treatment targets or monitoring the effectiveness of lifestyle changes.
Ultimately, in the management of patients with diabetes or obesity, the goal should not be simply to “lower cholesterol,” but to correct the altered lipoprotein architecture. Recognizing AD through NMR-based molecular profiling makes it possible to address residual risk and prevent cardiovascular events in a population that might otherwise be mistakenly considered low risk.
