Who needs to care about small, dense low density lipoproteins?

Background: Increasing evidence suggest that the ‘quality’ rather than only the‘quantity’ of low-density lipoprotein (LDL) exerts a great influence on the cardiovascularrisk. Small, dense LDL seem to be an important predictor of cardiovascularevents and progression of coronary artery disease (CAD) and their predominancehas been accepted as an emerging cardiovascular risk factor by the National CholesterolEducation Program Adult Treatment Panel III. Discussion: Some studiesshowed in past years that small, dense LDL are usually elevated in patients at veryhigh cardiovascular risk, such as those with CAD and type 2 diabetes. Morerecently elevated levels of these particles have been found in other categories ofpatients at high cardiovascular risk, such as those with non-coronary forms of atherosclerosis(e.g. with carotid artery disease, aortic abdominal aneurysm andperipheral arterial disease) and metabolic diseases (with polycystic ovary syndromeand growth hormone deficiency); notably, in most of them, the predominance ofsmall, dense LDL characterised their type of dyslipidaemia, alone or in combinationwith elevated triglycerides and reduced high-density lipoproteins cholesterol concentrations.Conclusions: The therapeutical modulation of small, dense LDL havebeen shown to significantly reduce cardiovascular risk and weight reduction andincreased physical activity may constitute first-line therapy. In addition, lipid-loweringdrugs are able to favourably alter these particles and fibrates and nicotinic acidseem to be the most effective agents. Promising data are also available with theuse of rosuvastatin, the latest statin introduced in the market, and ezetimibe, acholesterol absorption inhibitor