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Cholesterol subfractions
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Questions in the Cardiovascular Disease Prevention forum are answered by Dr. Lee Kirksey, associate professor at The University of Pennsylvania School of Medicine.

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Cholesterol subfractions

Certain laboratories offer a cholesterol panel that breaks down LDL different patterns (ie, pattern A, pattern B, pattern A/B) and HDL into HDL2 and HDL3 as well as other subfractions of VLDL and Lp(a).  These laboratories state that things like: LDL pattern B is more atherogenic than pattern A, HDL2 is more protective than HDL3, and that Lp(a) is particularly atherogenic, etc.  How strong is the evidence for these assertions?  

It seems like most cardilogists are managing to a total weight of LDL and/or HDL.  The above subfractions seem only to be looked at when on the fence regarding treatment.  Is this because the relevance of these subfractions are not well established?

Lastly, where can one find data on the affects of the various statin drugs on LDL patterns, HDL2, LDL particle numbers, and Lp(a)?

Thanks in advance
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There is compelling evidence that these test results add to creating a more accurate risk profile structure for each patient. No single study stands alone but integrated they appear to be more helpful. Visit berkeley heart panel at http://www.bhlinc.com/clin_test.php#4 to learn more about each indices. If you download the clinical manual, it is full of references for the data supporting the role and significance of each of these particles.

Most recently, more information has surfaced that elevated levels of Lp (a) are significant. With regards to your question about what most cardiologists are doing, across the board- I dont think the majority of cardiolgists are utilizing these studies in the management of their patients. When cardiologists aggressively treat patients with high risk profiles who may have nl or borderline elevated lipid panels- the benefits are probably a function of the subfractionated particles being high. Its just that the subfraction was not measured
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