Traditional and Novel Markers: Target of Treatment vs Marker of Risk.

ABSTRACT

In this article we discuss lipid-related markers associated with cardiovascular (CV) risk, and emphasize the significance of low-density lipoprotein (LDL) cholesterol (LDL-C), non-high-density lipoprotein cholesterol, and apolipoprotein B100. LDL-C, a traditional CV risk factor, correlates directly with atherosclerotic CV disease. However, LDL-C alone, usually estimated using the Friedewald equation, might not capture the entire risk profile. Therefore, triglycerides (TGs) and lipoprotein(a) [Lp(a)] should be measured as part of a complete CV risk assessment. Although TGs represent potential markers of increased CV risk, their role as direct causal agents remains inconclusive. Elevated TG levels suggest a greater cholesterol presence in non-LDL particles, necessitating the use of non-high-density lipoprotein cholesterol or apolipoprotein B100, rather than solely LDL-C, to ensure an accurate CV risk assessment. Lp(a), however, is a genetically determined particle resembling LDL, linked with various significant CV diseases. Its role in CV risk is potentially because of its added inflammatory and prothrombotic properties. Certain medications (most notably proprotein convertase subtilisin/kexin type 9 inhibitors and novel small interfering RNA molecules) can reduce Lp(a) levels. Whether this confers a benefit in preventing CV outcomes requires validation from ongoing trials. Although LDL-C remains a crucial metric, health care professionals must acknowledge its limitations and understand the emerging significance of TGs and Lp(a) in CV risk assessment. This article underscores the need to reevaluate traditional lipid markers in light of emerging evidence on TGs and Lp(a) to promote a more comprehensive approach to CV risk assessment.