Advanced lipoprotein testing does not improve identification of subclinical atherosclerosis in young adults: The bogalusa heart study

Background: The clinical value of advanced lipoprotein testing relative to traditional lipid testing remains controversial. To date, no studies have evaluated associations between advanced lipoprotein testing and subclinical atherosclerosis in healthy young adults. Objective: To determine whether advanced lipoprotein testing using vertical-spin density-gradient ultracentrifugation better predicts carotid intima-media thickness, a validated measure of subclinical atherosclerosis, than does traditional lipoprotein testing in asymptornatic young adults. Design: Cross-sectional community-based study. Setting: Bogalusa, Louisiana. Participants: 311 randomly selected adults from the Bogalusa Heart Study who were 20 to 38 years of age. Measurements: The authors performed advanced lipoprotein testing using vertical-spin density-gradient ultracentrifugation, traditional testing using enzymatic methods, and Friedewald formula estimation of low-density lipoprotein cholesterol levels. A certified reader blinded to lipoprotein results determined carotid intimamedia thickness by B-mode ultrasonography. C-statistics from area under the receiver-operating characteristic curves (ALICs) derived from multivariable regression models were compared. Results: Lipid values obtained with advanced lipoprotein testing did not predict carotid intima-media thickness better than traditionally measured lipid values in 236 participants for whom all data were available. A model using traditional lipoprotein measures (AUC, 0.754 [95% Cl, 0.690 to 0.812]) did not differ significantly from a model using advanced lipoprotein measures (AUC, 0.779 [Cl, 0.662 to 0.871]) for prediction of carotid intimamedia thickness (P > 0.2). Subclass pattern of LDL, lipoprotein(a) cholesterol, intermediate-density lipoprotein cholesterol, high-density lipoprotein cholesterol subclasses, and very- low-density lipoprotein subclasses did not improve the performance of models for prediction of carotid intima-media thickness. Limitations: The study was cross-sectional, cardiac events were not determined, and only 1 method of advanced lipoprotein testing was used. Conclusions: Advanced lipoprotein testing using vertical-spin density-gradient ultracentrifugation did not improve prediction of carotid intima-media thickness in young adults and may not be useful for assessing cardiovascular risk in this population.