Levels and correlates of LDL and VLDL particle sizes among children: the Bogalusa heart study
Introduction
The initial stages of atherosclerosis among children and young adults vary by race, sex and age, and are associated with lipid levels [1], [2]. Of the various lipoprotein classes, levels of high density lipoprotein (HDL) cholesterol among adolescents show the most striking changes with age, but there are also differences in levels of triglyceride (TG) and low-density lipoprotein (LDL) cholesterol. TG levels are substantially higher among white children than among black children, and tend to increase with age among whites [3], [4]. Although the mean LDL cholesterol level is higher among girls than boys, this difference narrows during sexual maturation [4].
Despite the importance of these lipids and lipoproteins in the development of atherosclerosis, the traditional risk factors are only moderately predictive of coronary heart disease (CHD). This misclassification may, in part, arise because the standard, density-based classification of lipoproteins (very-low, low, and high) results in heterogeneous categories that contain particles differing in diameter, composition, and possibly, atherogenicity [5], [6]. Although LDL subclasses have received the most attention [7], [8], [9], subclasses of very-low-density lipoproteins (VLDL) may also differ in atherogenicity [10], [11]. In addition, large VLDL particles may reflect delayed chylomicron clearance [12], a metabolic condition that has been related to disease severity [13], [14].
Despite the potential importance of lipoprotein subclasses, few studies [15], [16], [17] have examined these characteristics in early life. The current analyses, based on the analysis of frozen, archived plasma samples, describe the distribution of LDL and VLDL subclasses and particle sizes by race, sex, age, insulin levels, and relative weight.
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Sample
The 918 children and adolescents in the current analyses participated in the 1992–94 examination of the Bogalusa heart study, an epidemiologic study of cardiovascular disease risk factors in early life [18]. The surrounding community, Ward Four of Washington Parish (Louisiana), is fairly typical of semi-rural towns in the South, with an economy that is dominated by a lumber mill; the 1990 population of 43 000 was ≈1/3 black. Cross-sectional examinations of 5–17-year-olds have been conducted in
Results
The reproducibility of the examined characteristics is shown in Table 1. Among the 92 pairs of replicate NMR determinations, intra-class correlation coefficients (ICC) ranged from 0.69 (LDL size) to 0.97 (levels of intermediate VLDL); these values can be compared with ICCs above 0.95 for the chemically determined lipid levels. The modest ICC (0.69) for LDL size, along with its very low CV (1%), indicates that the small intra-pair differences were relatively large when compared to the
Discussion
Most studies of lipoprotein subclasses have focused on LDL, with high levels of small, dense particles having been found to be predictive of CHD [5], [7], [8], [9], [27]. Although there are several mechanisms by which small LDL particles could promote atherosclerosis [27], [28], many (but not all [9]) investigators have found that adjustment for lipid levels greatly reduces the magnitude of the association with CHD risk [7], [8]. It is also likely that VLDL subclasses differ in atherogenicity,
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