LPP Plus

The LPP (Lipoprotein Particle Profile) Plus by SpectraCell Laboratories is designed to provide a more detailed and accurate assessment of cardiovascular risk compared to traditional cholesterol testing methods. This test uses analytical ultracentrifugation, the CDC gold standard for lipoprotein testing, then measures the particles photometrically.  

Lipoprotein particles play a key role in cholesterol homeostasis, plaque formation and the development of cardiovascular disease.  Unlike conventional tests that only measure cholesterol and triglyceride levels, the LPP Plus test measures 12 lipoprotein particles in the blood to determine cardiovascular risk. In measuring several classes of lipoprotein particles it may provide additional insight into an individual’s risk of developing cardiovascular disease beyond what a simple lipid panel can identify, and offer actionable insights and individualized care options for managing and mitigating cardiovascular risk​​. 

What Does the LPP Plus By SpectraCell Laboratories Include?

The LPP Plus Profile by Spectracell Laboratories includes various biomarkers, each chosen for its clinical relevance in assessing cardiovascular risk and overall health. Here is a list of biomarkers included in the panel along with their rationales:

The LPP Plus by Spectracell includes a standard lipid panel, with the following markers:

Total Cholesterol: total cholesterol levels are a fundamental marker for assessing cardiovascular risk. Elevated total cholesterol levels are associated with increased risk of atherosclerosis and coronary artery disease (CAD).  [7.]

HDL Cholesterol: high-density lipoprotein (HDL) cholesterol is often referred to as "good" cholesterol because it helps remove cholesterol from the bloodstream, reducing the risk of atherosclerosis and cardiovascular events.  [2.]

LDL Cholesterol: low-density lipoprotein (LDL) cholesterol is considered the primary target for cholesterol-lowering therapy because elevated LDL cholesterol levels are strongly associated with increased risk of atherosclerosis and CAD.  [2., 7.]

Non-HDL Particles: non-HDL particles include LDL, VLDL, and intermediate-density lipoprotein (IDL) particles. Elevated non-HDL cholesterol levels are strongly associated with increased risk of cardiovascular disease, especially in patients with diabetes or metabolic syndrome.  [5.] 

Triglycerides: triglycerides are fat particles in the blood that come from recent dietary intake of saturated fat, simple carbohydrates, and/or alcohol.  Elevated triglyceride levels may signal dysfunctional metabolic processes including insulin resistance, fatty liver, and they are associated with an increased risk of cardiovascular disease.  [10.]

In addition to a standard lipid panel, the LPP Plus by Spectracell Laboratories also includes the following biomarkers that may provide insights into cardiovascular risk assessment beyond traditional lipid panel measurements:

VLDL Particles: very-low-density lipoprotein (VLDL) particles are a precursor to LDL particles and play a crucial role in lipid metabolism. Elevated VLDL levels are associated with increased risk of atherosclerosis and cardiovascular disease.  [3]

Total LDL Particles (LDL-P): measuring the number of LDL particles gives different information than LDL-C, which is the amount of cholesterol that’s carried by LDL particles.  Knowing the number of LDL particles present in the bloodstream provides a more comprehensive assessment of cardiovascular risk than LDL-C alone because the size of LDL particles also confers cardiovascular risk, with smaller LDL particles being more atherogenic.  Therefore, in two people with the same LDL-C number, the person with a higher LDL-P (and therefore more small LDL particles present in his or her bloodstream) has a higher risk for a cardiovascular event than the person with the lower LDL-P.  [11.]

Remnant Lipoprotein: remnant lipoproteins, remnants of VLDL and chylomicrons after triglyceride hydrolysis, are atherogenic particles associated with increased risk of cardiovascular events, even in individuals with normal LDL cholesterol levels. [12., 17.]

Dense LDL III and Dense LDL IV: small dense LDL (sdLDL) subfractions, particularly LDL III and LDL IV, are more atherogenic than larger, buoyant LDL particles. Measuring these subfractions provides additional information for assessing cardiovascular risk beyond traditional lipid panels.  [13.]

Total HDL Particles: total HDL particle concentration provides insight into HDL metabolism and reverse cholesterol transport, with higher levels being associated with reduced cardiovascular risk. [9.]

Buoyant HDL 2b: buoyant HDL 2b particles are considered particularly cardioprotective due to their role in reverse cholesterol transport. Higher levels of buoyant HDL 2b are associated with reduced risk of cardiovascular events. [6.]

Homocysteine: elevated homocysteine levels are associated with increased risk of cardiovascular disease, including atherosclerosis, stroke, and venous thromboembolism.  [14.]

Lipoprotein(a): Elevated lipoprotein(a) levels are an independent risk factor for cardiovascular disease, particularly in individuals with a family history of premature heart disease.  It is important to note that Lp(a) levels are genetically determined and change little, if at all, in response to diet and lifestyle.  [15.]

Apolipoprotein B (ApoB): Apolipoprotein B is a structural component of atherogenic cholesterol particles including VLDL, IDL, LDL and Lp(a)  particles and is considered a more accurate predictor of cardiovascular risk compared to LDL cholesterol levels alone, particularly in the setting of insulin resistance and diabetes.  [1.]

Apolipoprotein A1 (apoA1): apoA1 is attached to the surface of HDL particles, and is associated with a cardioprotective effect.  Elevated apoA1 levels are associated with improved HDL functionality and reduced cardiovascular risk, while low levels are independently linked to increased risk of cardiovascular events. Monitoring apoA1 levels allows for better risk prediction and assessment of therapeutic efficacy in managing cardiovascular disease risk. [8.]

hs-CRP (High-Sensitivity C-Reactive Protein): elevated hs-CRP levels are indicative of systemic inflammation and are associated with increased risk of cardiovascular events, including myocardial infarction and stroke.  [4.]

Insulin: fasting insulin levels are markers of insulin resistance, a condition associated with metabolic syndrome, type 2 diabetes, and increased risk of cardiovascular disease.  [16.]

Who should get an LLP Plus?

The LPP Plus test by SpectraCell Laboratories is particularly beneficial for individuals who may have a higher risk of cardiovascular disease (CVD), even if traditional lipid panel results are within normal ranges. Specific groups of people who might benefit most from this test include:

Individuals with a family history of heart disease or stroke: Genetic factors can play a significant role in an individual's risk for developing cardiovascular diseases. Those with a family history of these conditions may have inherited risks not visible in traditional lipid tests.

Patients with existing heart disease or those who have had a heart attack or stroke: For these patients, the LPP Plus can provide a deeper understanding of their lipid profile and help manage their condition more effectively.

Individuals with diabetes or pre-diabetes: Since diabetes significantly increases the risk of heart disease, understanding the detailed lipid profile can help in managing these risks more effectively.

People with metabolic syndrome: Metabolic syndrome is a cluster of conditions that increase the risk of heart disease, stroke, and type 2 diabetes. The LPP Plus can offer insights into specific lipid abnormalities associated with this syndrome.

Patients with high-normal LDL cholesterol levels on traditional lipid panels: Even if LDL cholesterol levels seem within normal ranges, the LPP Plus test can uncover the presence of small, dense LDL particles that are more atherogenic and pose a greater risk for cardiovascular disease.

Individuals with normal cholesterol levels who have heart disease: Some individuals develop heart disease despite having normal cholesterol levels, a condition sometimes referred to as "normal cholesterol heart disease." The LPP Plus test can help identify underlying risks not apparent in a standard lipid panel.

Patients seeking a more comprehensive cardiovascular risk assessment: Those interested in a detailed understanding of their cardiovascular health, beyond what traditional cholesterol tests offer, may choose the LPP Plus for its comprehensive analysis.

By providing a detailed breakdown of lipoprotein particle size and density, along with other cardiovascular risk markers, the LPP Plus test can help healthcare providers offer personalized treatment plans. It's particularly suited for individuals at risk or seeking a more in-depth analysis of their cardiovascular health to make informed decisions about lifestyle changes and treatments.

References

[1.] Behbodikhah J, Ahmed S, Elyasi A, Kasselman LJ, De Leon J, Glass AD, Reiss AB. Apolipoprotein B and Cardiovascular Disease: Biomarker and Potential Therapeutic Target. Metabolites. 2021 Oct 8;11(10):690. doi: 10.3390/metabo11100690. PMID: 34677405; PMCID: PMC8540246.

[2.] Centers for Disease Control and Prevention. LDL & HDL: Good & Bad Cholesterol. Centers for Disease Control and Prevention. Published 2017. https://www.cdc.gov/cholesterol/ldl_hdl.htm 

[3.] Das P, Ingole N. Lipoproteins and Their Effects on the Cardiovascular System. Cureus. 2023 Nov 15;15(11):e48865. doi: 10.7759/cureus.48865. PMID: 38106760; PMCID: PMC10724412.

[4.] Fonseca FA, Izar MC. High-Sensitivity C-Reactive Protein and Cardiovascular Disease Across Countries and Ethnicities. Clinics (Sao Paulo). 2016 Apr;71(4):235-42. doi: 10.6061/clinics/2016(04)11. PMID: 27166776; PMCID: PMC4825196.

[5.] Ghodsi S, Meysamie A, Abbasi M, Ghalehtaki R, Esteghamati A, Malekzadeh MM, Asgari F, Gouya MM. Non-high-density lipoprotein fractions are strongly associated with the presence of metabolic syndrome independent of obesity and diabetes: a population-based study among Iranian adults. J Diabetes Metab Disord. 2017 Jun 7;16:25. doi: 10.1186/s40200-017-0306-6. PMID: 28596946; PMCID: PMC5463311.

[6.] He Y, Kothari V, Bornfeldt KE. High-Density Lipoprotein Function in Cardiovascular Disease and Diabetes Mellitus. Arterioscler Thromb Vasc Biol. 2018 Feb;38(2):e10-e16. doi: 10.1161/ATVBAHA.117.310222. PMID: 29367232; PMCID: PMC5804739.

[7.] Jung E, Kong SY, Ro YS, Ryu HH, Shin SD. Serum Cholesterol Levels and Risk of Cardiovascular Death: A Systematic Review and a Dose-Response Meta-Analysis of Prospective Cohort Studies. Int J Environ Res Public Health. 2022 Jul 6;19(14):8272. doi: 10.3390/ijerph19148272. PMID: 35886124; PMCID: PMC9316578. 

[8.] Karjalainen MK, Holmes MV, Wang Q, et al. Apolipoprotein A-I concentrations and risk of coronary artery disease: A Mendelian randomization study. Atherosclerosis. 2020;299:56-63. doi:https://doi.org/10.1016/j.atherosclerosis.2020.02.002

[9.] Kontush A. HDL particle number and size as predictors of cardiovascular disease. Front Pharmacol. 2015 Oct 5;6:218. doi: 10.3389/fphar.2015.00218. PMID: 26500551; PMCID: PMC4593254.

[10.] Miller M, Stone NJ, Ballantyne C, et al. Triglycerides and cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2011;123(20):2292-2333. doi:https://doi.org/10.1161/CIR.0b013e3182160726

[11.] Otvos JD, Mora S, Shalaurova I, Greenland P, Mackey RH, Goff DC Jr. Clinical implications of discordance between low-density lipoprotein cholesterol and particle number. J Clin Lipidol. 2011 Mar-Apr;5(2):105-13. doi: 10.1016/j.jacl.2011.02.001. PMID: 21392724; PMCID: PMC3070150.

[12.] Packard CJ. Remnants, LDL, and the Quantification of Lipoprotein-Associated Risk in Atherosclerotic Cardiovascular Disease. Curr Atheroscler Rep. 2022 Mar;24(3):133-142. doi: 10.1007/s11883-022-00994-z. Epub 2022 Feb 17. PMID: 35175548; PMCID: PMC8983627.

[13.] Qiao YN, Zou YL, Guo SD. Low-density lipoprotein particles in atherosclerosis. Front Physiol. 2022 Aug 30;13:931931. doi: 10.3389/fphys.2022.931931. PMID: 36111155; PMCID: PMC9468243.

[14.] Refsum H, Ueland PM, Nygård O, Vollset SE. Homocysteine and cardiovascular disease. Annu Rev Med. 1998;49:31-62. doi: 10.1146/annurev.med.49.1.31. PMID: 9509248.

[15.] Reyes-Soffer G, Ginsberg HN, Berglund L, et al. Lipoprotein(a): A Genetically Determined, Causal, and Prevalent Risk Factor for Atherosclerotic Cardiovascular Disease: A Scientific Statement From the American Heart Association. Arteriosclerosis, Thrombosis, and Vascular Biology. 2021;42(1). doi:https://doi.org/10.1161/atv.0000000000000147