Changing the Cholesterol-Centric Paradigm for the Assessment of the Proatherogenic Potential of Low-Density Lipoproteins

In this issue of the journal , Dr. Yasuki Ito from Denka-Seiken, along with colleagues, describes the development of a novel direct assay for the measurement of the triglyceride content of LDL (LDL-TG2; 1). It has been known for over 100 years, since the pioneering work of Dr. N. Anitschkow in 1913 (2), that plasma cholesterol plays a central role in the pathogenesis of atherosclerosis. Much later in the mid-1950s, Dr. John Gofman first showed that, by separating lipoproteins via analytical ultracentrifugation, cholesterol on LDL (LDL-C) is positively related to cardiovascular disease risk, whereas cholesterol on HDL (HDL-C) is inversely related (3). Most recently, however, there has been a growing awareness of the importance of the compositional complexity of lipoproteins, and the possibility that other lipid and protein components of lipoproteins besides cholesterol can also serve as biomarkers (4). In fact, in a 2004 study by Dr. Winfried Marz and colleagues, it was first reported that LDL-TG was superior to LDL-C as a cardiovascular disease risk predictor (5). This study, however, employed a tedious ultracentrifugation-based method that is not suitable for routine clinical laboratory testing, and as a …