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ARS Home » Northeast Area » Boston, Massachusetts » Jean Mayer Human Nutrition Research Center On Aging » Research » Publications at this Location » Publication #233316
Title: Comparability of Methods for LDL Subfraction Determination: A Systematic Review

Author
item CHUNG, MEI - TUFTS MEDICAL CENTER
item Lichtenstein, Alice
item IP, STANLEY - TUFTS MEDICAL CENTER
item LAU, JOSEPH - TUFTS MEDICAL CENTER
item BALK, ETHAN - TUFTS MEDICAL CENTER

Submitted to: Atherosclerosis
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 12/8/2008
Publication Date: 12/14/2008
Citation: Chung, M., Lichtenstein, A.H., Ip, S., Lau, J., Balk, E.M. 2008. Comparability of Methods for LDL Subfraction Determination: A Systematic Review. Atherosclerosis. 205(1)342-348.

Interpretive Summary: Identifying and aggressively treating individuals at high risk of developing heart disease is critical to optimizing health outcomes of the U.S. population. The heart disease risk factors defined by the National Cholesterol Education Program do not identify all individuals at high risk of developing heart disease. Prior to adopting a new heart disease risk factor with the intent of improving risk prediction the methodology used to measure the new risk factor relative must be validated relative to a well established reference method. Low density lipoprotein (LDL) subfractions have been identified as a potential additional risk factor. Currently, there is no reference method for evaluating LDL subfractions or standardization among the different methods used to measure LDL subfractions. We conducted a systematic review to identify reports comparing two or more methods of measuring LDL subfractions. Nine articles were identified that separated and quantified LDL subfractions, involving three different approaches to measuring the particles. Comparative data were available for nuclear magnetic resonance versus gel electrophoresis (GE), LipoPrint (trademark) versus other GE methods, ultracentrifugation versus GE, and high performance gel filtration chromatography versus GE. We found a wide range of agreement among methods for LDL subfraction determinations. It was difficult to directly compare the methods because different criteria and definitions were used to classify individuals with respect to heart disease risk. In summary, the currently available literature does not provide adequate data about comparability in terms of test performance to choose one or another as a standard method for use as a risk factor of heart disease. In addition, there are no data available on comparability in terms of predicting heart disease outcomes.

Technical Abstract: Identifying and aggressively treating individuals at elevated risk of cardiovascular disease (CVD) is critical to optimizing health outcomes. The CVD risk factors defined by the National Cholesterol Education Program do not fully predict individuals at high risk of developing CVD. Essential to the adoption of a potential new risk factor to improve risk prediction is validation against a reference method. Low density lipoprotein (LDL) subfraction has been advanced as a potential additional risk factor. Currently, there is no reference method for evaluating LDL subfractions or standardizing different methods used to measure LDL subfractions. We conducted a systematic review to identify reports comparing two or more methods of measuring LDL subfractions. Nine articles were identified that separated and quantified LDL subfractions. Comparative data were available for nuclear magnetic resonance versus gel electrophoresis (GE), LipoPrint (trademark) versus other GE methods, ultracentrifugation versus GE, and high performance gel filtration chromatography versus GE. We found a wide range of agreement (from 7% to 94% concordance for classifying LDL patterns) among methods for LDL subfraction determinations. Different criteria and definitions were used to classify individuals with respect to CVD risk. No study used CVD or other clinical outcomes as a reference standard. In summary, the currently available literature does not provide adequate data about comparability in terms of test performance to choose one or another as a standard method and no data on comparability in terms of predicting CVD outcomes are available.