Proposal for a New Lipid Disorder Classification

Presented: DALM New York 2001; IAS Rome 2006

Abstract

The author proposes a new classification of lipid disorders based on the atherogenic-anti-
atherogenic balance between the low-density lipoprotein cholesterol (LDL) entering the artery wall and the high-density lipoprotein cholesterol (HDL) being removed from the arterial wall. The proposed lipid grouping is termed lipid risk classification (LRC). LRC I is comprised of patients with high LDL and low HDL. LRC II is comprised of patients with high LDL and normal HDL. LRC III is comprised of patients with normal LDL and low HDL. LRC IV is comprised of patients with normal LDL and HDL. Each LRC grouping is stratified by triglycerides (TG), with “A” subgroups having normal TG and “B” subgroups having high TG.

The advantage to a LRC grouping is enhanced ability to predict risk of atherothrombotic disease brought to an isolated LDL by incorporating HDL and TG. In addition the decision to treat or not to treat and the choice of therapeutic modality is enhanced by the LRC grouping. Finally, this classification unifies the usual LDL disorders with the so-called metabolic syndrome.

Introduction

Lipid disorders are a recognized cause of atherothrombotic disease (ATD) and are second only to cigarette smoking as a cause of ATD. (1) At present, however, there exists no practical classification of lipid disorders. Since the only reason to treat lipid disorders (besides severe elevation of TG leading to pancreatitis) is the prevention of ATD, a lipid classification based on the functional significance of lipids with regard to the risk of ATD would be valuable.

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