Because so many different factors – some still unknown – are involved in the development of atherosclerosis and coronary artery disease (CAD), it's difficult to accurately predict an individual’s risk for a heart attack. However, if someone suffers from extreme derangements or other disorders, the risk may be vastly increased.
The good news is that, for the majority of the population, preventative lifestyle interventions reduce the risk of future illness can to a great extent.
Armed with information about lipoproteins, techniques were developed to measure "good" high density lipoprotein (HDL) and "bad" low density lipoprotein (LDL) cholesterol separately. Further research also began to illuminate the biological and other factors which determine the levels of these two plasma lipoproteins.
Levels of LDL cholesterol are directly linked to those of another protein – apoB – which is almost entirely carried by LDL. So, instead of measuring LDL cholesterol, scientists realised that measurement of apoB would give similar (but not identical) information.
It was also discovered that the LDL packages themselves became smaller and denser in certain disorders, including hypertriglyceridaemia (the medical term for raised triglyceride levels). Smaller LDL is usually associated with higher triglycerides and lower HDL cholesterol but other associations include obesity and diabetes.
Small LDL at the same cholesterol value than large LDL is more likely to cause atherosclerosis.Reviewed by Prof David Marais, FCP(SA), Head of Lipidology at Groote Schuur Hospital and the University of Cape Town. February 2018.