| CRP |
| ADVANCED LIPOPROTEIN TESTING |
| METABOLIC SYNDROME |
| LOW RISK | <1.0 mg/L |
| AVERAGE RISK | 1.0 TO 3.0 mg/L |
| HIGH RISK | >3.0 mg/L |
| LDL confers increased CHD risk; HDL confers reduced risk. |
| Smaller and denser LDL particles are more atherogenic than large ones. They diffuse into the vascular wall more earily; and more easily oxidized and glycated, inducing endothelial dysfunction and development of the atherisclerotic plaque. |
| Large particle HDL are more likely to slow CHD progression. |
| Elevated triglycerides (TG) levels stimulate a series of enzymatic steps that ultimately lead to increased production of small dense HDL and LDL particles. Patients with high non-HDL-C (TC minus HDL-C) are likely to have these small dense particles. |
| Other factors for small dense LDL are: glucose intolerance and obesity. |
| LDL particle number: Each VLDL and LDL particle contains 1 molecule of apolipoprotein B (apo B). Measuring apo B provides a good estimate of LDL particle number. However, apo B tells little about LDL particle size. |
| LDL size and densirty measurement: Gradient gel electrophoresis eparates LDL particles by size; ultracentrifugation measures particle density. |
| NMR measurement: Nuclear magnetic resonance (NMR) spectroscopy of lipoproteins uses a magnetic resonance signal to measure size and number of all different subclasses of LDL and HDL as well as VLDL and IDL (intermediate density lipoproteins). |
| Advanced lipoprotein testing may help predict CHD. LDL particle size and number are additionally predictive of CHD beyond the traditional lipid measures. |
| NCEP (National Cholesterol Education Program) |
| The features of MBS (3 of 5 make the diagnosis) are: abdominal obesity; atherogenic dyslipidemia (triad of high triglycerides, low HDL-C, and high LDL-C); hypertension; insulin resistance; prothrombotic state; and proinflammatory state. Some include: hyperuricemia, hyperglycemia, and endothelial dysfunction. |
| Abdominal
obesity (waist circumference) Men >40 in Women >35 in |
| Triglycerides >150 mg/dL |
| HDL-C Men <40 mg/dL Women <50 mg/dL |
| Blood pressure >130/85 |
| Fasting blood glucose >110 mg/dL |
| Presence of 3 required for diagnosis |
| WHO (World Health Organization) |
| Hyperinsulinemia (upper quartile of the nondiabetic population), or insulin resistance defined as the highest quartile of the HOMAir i(Homeostatic model assessment for insulin resistance) ndex on the nondiabetic population or fasting plasma glucose > 110 mg/dL |
| At least 2 of the following: |
| Hypertension (Blood pressure > 160 mm Hg systolic or > 90 mm Hg diastolic) or on antihypertensive medication |
| Dyslipidemia an elevated plasma triglycerides (>150 mg/dL) and/or low HDL cholesterol concentrations (<35 mg/dL in men, <39 mg/dL in women) |
| Obesity a high BMI >30 kg/m2, and/or a high waist to hip ratio (>0.90 in men, >0.85 in women) |
| Microalbuminuria Urinary albumin excretion rate > 20 ug/min |
| Modified WHO definition |
| Hyperinsulinemia (upper quartile of the nondiabetic population) or fasting plasma glucose > 110 mg/dL |
| At least 2 of the following: |
| Hypertension (Blood pressure > 140.90 mm Hg) or on antihypertensive medication |
| Dyslipidemia Serum triglycerides >150 mg/dL) or HDL cholesterol <35 mg/dL in men, <45 mg/dL in women) |
| Abdominal
obesity - Metabolic syndrome WHO definition with waist-hip ration >0.90 or BMI >30 kg/m2 - Metabolic syndrome, WHO definition with waist girth >40 inches in men and >39 inches in women |
