Lipoprotein Subfractionation: Medium LDLs (ION)

Optimal Takeaways

Research suggests that small LDL particles are more closely linked to an increased cardiovascular disease (CVD) risk. However, medium-sized LDL particles may also contribute to this risk.

Medium LDLs are associated with an atherogenic pattern called phenotype B, which includes smaller LDLs, larger HDLs, increased triglycerides, and a higher risk of CVD, metabolic syndrome, insulin resistance, and type 2 diabetes. Genetic factors can influence LDL and HDL sizes, and medium LDLs have been linked to increased coronary artery calcium in high-risk individuals.

Standard Range: 0.00 – 214.99 nmol/L                    

The ODX Range: 0.00 – 214.99 nmol/L ­­

Low levels of medium LDLs suggest a lower risk of cardiovascular disease.

High levels of medium LDLs may be associated with genetic factors, increased triglycerides, decreased HDL-C, and increased risk of CVD, metabolic syndrome, and diabetes (Musunuru 2009).

Overview    

Although abundant research indicates that small LDL particles are more atherogenic and more closely associated with an increased risk of CVD, medium-sized LDLs may also confer increased risk. Medium LDLs measure in the range of 21.41-22.0 nm, while small and very small LDLs measure in the range of 20.82–21.41 nm and 18.0–20.82 nm, respectively (Ceponiene 2021).

Medium LDLs are also associated with phenotype B, an atherogenic pattern associated with smaller LDLs, larger HDLs, increased triglycerides, increased risk of CVD, metabolic syndrome, insulin resistance, and type 2 diabetes. Genetic SNPs can influence the size and distribution of LDL and HDL (Musunuru 2009).

Medium LDLs were associated with increased coronary artery calcium in a study of 182 high-risk individuals with metabolic syndrome or diabetes. LDL cholesterol levels were not associated with or indicative of coronary artery calcium. Researchers recommend lipoprotein subfractionation studies in those individuals at high risk of cardiometabolic dysfunction (Aneni 2019).

References  

Aneni, Ehimen C et al. “Lipoprotein Sub-Fractions by Ion-Mobility Analysis and Its Association with Subclinical Coronary Atherosclerosis in High-Risk Individuals.” Journal of atherosclerosis and thrombosis vol. 26,1 (2019): 50-63. doi:10.5551/jat.40741

Ceponiene, Indre et al. “Association of Coronary Calcium, Carotid Wall Thickness, and Carotid Plaque Progression With Low-Density Lipoprotein and High-Density Lipoprotein Particle Concentration Measured by Ion Mobility (From Multiethnic Study of Atherosclerosis [MESA]).” The American journal of cardiology vol. 142 (2021): 52-58. doi:10.1016/j.amjcard.2020.11.026

Musunuru, Kiran et al. “Ion mobility analysis of lipoprotein subfractions identifies three independent axes of cardiovascular risk.” Arteriosclerosis, thrombosis, and vascular biology vol. 29,11 (2009): 1975-80. doi:10.1161/ATVBAHA.109.190405