Lipoprotein Tests

Liprotein Subfraction Test
This is an exacting blood test that divides your cholesterol into a variety of subparticles based on their size and density. While the Standard Lipid Profile tells you the quantity of total cholesterol, LDL, HDL, and triglycerides, this test will tell you the quality of your cholesterol. In particular, you will learn whether you have large amounts of small, dense LDL and/or small HDL particles, both of which put you at risk of having a heart attack or stroke.
Worried about your heart health? Find a cardiologist in your area.

The rate at which cholesterol gets into your vessel walls depends on the number and size of your LDL cholesterol particles. Small LDL particles containing less cholesterol per particle move into vessel walls more easily than larger particles. The smaller the particle, the more easily it moves in. That's why patients who have low total cholesterol levels and even low total LDL levels can still be at high risk for coronary disease if they have lots of small LDL. Patients with increased numbers of small LDL particles are classified as being pattern B. Those with large LDL particles are classified as pattern A.

Like small LDL, small HDL also has less cholesterol per particle. Patients with predominantly small HDL particles do not clear cholesterol from vessel walls as well as those with larger HDL particles. Small HDL also reduces the total cholesterol number, and this is another reason why patients with low total cholesterol may still be at risk for coronary disease. That's why it is important to know not just your total cholesterol and LDL numbers, but also the size of your particles.

People who have small LDL and HDL along with high triglycerides have what is called the atherogenic lipid profile and must be treated aggressively. These lipid factors are associated with a sedentary lifestyle, obesity, prediabetes, and diabetes — and will accelerate the development of atherosclerosis. A program of weight loss and regular exercise can help to reverse these lipid abnormalities. Taking medications such as Niaspan (prescription niacin), TriCor (fenofibrate), or one of the so-called TZD agents, Avandia (rosiglitazone maleate) or Actos (pioglitazone hydrochloride), can also help.

Lipoprotein (a) Test
Lipoprotein (a), or Lp(a), is a type of LDL particle with a protein called "little a" attached. An increased number of these particles is associated with an increased risk of coronary disease when Lp(a) is greater than 30 mg/dL. (This number could be slightly higher or lower depending on the lab that analyzes the blood test.) This risk is multiplied when Lp(a) is associated with other blood lipid abnormalities, such as elevated LDL.

How Lp(a) actually affects your blood vessels is still not well understood, but you can think of it as making the endothelial lining of the arterial walls more porous to LDL particles. Thus, Lp(a) facilitates the development of plaque, which can lead to heart attacks. Lp(a) is unique in that it does not respond to lifestyle changes. Niacin is the only medication that effectively lowers Lp(a), though it often requires high doses.
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