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PrintQ. What is “residual risk?”
A. The most recent guidelines (The National Cholesterol Education Program Adult Treatment Panel III) introduced the concept of “residual risk.” While LDL-cholesterol accounts for the majority of risk due to cholesterol and lipid particles, it does not take into account all the atherogenic (lipid particles that can promote build-up of plaque, or atherosclerosis) particles in your blood. For people at higher risk for CVD, it is important to consider residual risk initially or after LDL-cholesterol goal has been met. This can be estimated or measured in several ways. One is calculation of “non-HDL cholesterol” by subtracting HDL-cholesterol number from the Total Cholesterol. Other blood tests that evaluate residual risk are measurement of “Apolipoprotein B” or “LDL particle number.”
Q: What is Apolipoprotein B?
A: Apolipoproteins are proteins that are bound to cholesterol or lipid particles in your blood stream. They perform important functions such as helping to direct particles to specific places in your body (such as receptors that help remove them from your body or to arteries where they contribute to atherosclerotic plaque). Apolipoprotein B is the major protein on LDL cholesterol particles; each LDL particle has one Apolipoprotien B. However, there are other atherogenic lipid particles besides LDL that have Apolipoprotein B and contribute to the build-up of plaque in your arteries.
Q: What is LDL particle number?
A: Each particle of LDL contains cholesterol. The number reported on your lab report reflects the amount of cholesterol inside the particles. However, the number of particles has also been shown to be associated with risk for cardiovascular disease. It is the particle that carries the cholesterol and helps facilitate the deposition in your arteries and the build-up of plaque. Even though your LDL cholesterol number may be at goal, your Apolipoprotein B or LDL particle number may still be too high.
Q. Are Triglycerides and HDL-cholesterol still important?
A. Yes! Triglycerides are a form of fat that in too high levels is associated with risk for CVD. HDL-cholesterol is important as it helps to remove the bad cholesterol from your body (called “reverse cholesterol transport). It is not uncommon for people with diabetes to have high Triglycerides and low HDL-cholesterol. Lifestyle changes (diet, exercise, and weight loss) can influence levels of both but often medications are needed, in particular for elevated Triglyceride levels.
Read more of Dr. Myerson's columns.
NOTE: The information is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional medical advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition.
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