The relationship between Pattern B lipoprotein profile and low-density lipoprotein cholesterol subfractions with Metabolic Syndrome and Framingham Risk Score in adults at health screening in Malaysia.

Introduction: Traditional cardiovascular (CV) risk factors are constituents of Metabolic Syndrome (MetS) and Framingham Risk Score (FRS). However, CV risk exists even when these risk parameters are normal and have been attributed to the atherogenic small dense low-density lipoprotein cholesterol (sdLDL). This study aimed to determine the association of Pattern B and LDL subfractions with MetS and FRS among selected Malaysian population.

Materials and methods: A cross-sectional study of 380 subjects ≥30 years old at health screening. Sociodemographic factors and clinical characteristics were recorded. Fasting serum lipids, LDL subfractions and plasma glucose were analysed.

Results: Being older, Malay with Pattern B independently predicted MetS. Being male, Chinese with Pattern B and increased body mass index (BMI) and diastolic blood pressure (DBP) were more likely to be in the intermediate to high risk FRS group. Common independent biochemical predictors include LDL1 and sdLDL: LDL3 in MetS and non-high-density lipoprotein cholesterol in FRS.

Conclusion: BMI and DBP may provide incremental prognostic value to FRS risk estimates if included. Considering a significant incidence of Pattern B in low FRS risk subjects (13.4%), routine LDL subfraction analysis could identify these individuals that would be overlooked if their risk were predicted solely based on their FRS only. The non-specific lowering of LDL1 by lipid-lowering therapy based on conventional lipid profile might have a negative effect on several physiological processes. Hence, if LDL subfractions are determined, therapy can be targeted towards sdLDL. Recognising asymptomatic individuals who carry high CV risk is pertinent in primary prevention.