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Writer's pictureTorsak Tip-pairote

The LDL Paradigm Is Crumbling: A New Era in Cardiovascular Risk Assessment

New Study Highlights Key Insights on Lipids, Diabetes, and Heart Disease Risk. A large-scale study examined over 4,700 individuals, analyzing their lipoprotein profiles (cholesterol, triglycerides, and HDL composition) across glycemic stages, i.e. normoglycemia, prediabetes, and diabetes.


Key findings include:

  • People with prediabetes and diabetes had higher triglycerides and altered HDL composition (smaller, less functional HDL particles).

  • Interestingly, LDL cholesterol levels were lower in these groups, challenging traditional risk markers.

  • Triglyceride-rich lipoproteins (like VLDL) and dysfunctional HDL were strongly linked to subclinical coronary atherosclerosis (measured by coronary artery calcium score).


This study underscores that in metabolic disorders like prediabetes and diabetes:

  • Triglycerides and their impact on lipoproteins may play a bigger role in heart disease risk than cholesterol alone.

  • Dysfunctional HDL and small, dense LDL (driven by high triglycerides) are key culprits in plaque formation and arterial damage.

  • Managing LDL cholesterol alone isn’t enough—triglycerides, HDL quality, and overall lipoprotein function must be addressed.


Clinical Implications:

For individuals with metabolic disorders:

1.      Focus on triglycerides and non-HDL cholesterol alongside LDL-C in risk assessments.

2.      Lifestyle changes (exercise, healthy fats, and weight loss) + triglyceride-targeting treatments (fibrates, omega-3s) can boost HDL function and reduce atherogenic lipoproteins.

3.      Lipid-lowering medications (statins) remain vital but should be complemented by therapies targeting triglycerides and remnant lipoproteins.

Cardiovascular health is more than just “bad cholesterol.” Triglycerides, lipoprotein composition, and HDL quality matter—especially for those with diabetes or prediabetes. Let’s move toward precision lipid management for better heart health!

 

Gigante, B., et al., Lipoproteins and lipoprotein lipid composition are associated with stages of dysglycemia and subclinical coronary atherosclerosis. International Journal of Cardiology, 2025. 419.




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