Lipoprotein Subclass Measurements by an Updated Nuclear Magnetic Resonance Spectroscopy Method in the Prediction of Coronary Artery Disease in Type 1 Diabetes

The role of low density lipoprotein (LDL) cholesterol as a major risk factor for the development of cardiovascular disease is widely accepted. Indeed, major health organizations, such as the American Diabetes Association and the American Heart Association, recommend increased efforts to keep LDL concentrations within target as a means of subsequently reducing the incidence of atherosclerosis, especially among individuals with diabetes1. However, the role of high density lipoprotein (HDL) cholesterol in the development of cardiovascular disease is not as clear as that of LDL. Although earlier studies have suggested an inverse association between HDL cholesterol concentrations and CAD incidence2, more recently published data have also shown direct relationships. It has thus been proposed that the study of subfractions of HDL in relation to CAD incidence may clarify some of these discrepancies. In the early 2000s, lipoprotein subfractions by nuclear magnetic resonance spectroscopy (NMR) were measured as part of a nested, within the Epidemiology of Diabetes Complications study (EDC) cohort, coronary artery disease (CAD) case-control study in 142 study participants2, 3, 4, 5, 6, 7. Findings in this paper showed that increased large HDL particle concentration by NMR was related to a decreased CAD risk while medium HDL particle concentration by NMR was positively related to CAD incidence. The methodology of assessing lipoprotein subfractions by NMR has since been altered, however. Thus, during 2010, lipoprotein subfractions by nuclear magnetic resonance spectroscopy (NMR) were measured again in the EDC study, using an updated NMR methodology at the first available stored serum sample of EDC study participants. Thus, the aim of this paper was to compare assay results obtained using the earlier (version 1) NMR methodology with those using the most recent (version 3) NMR methodology, and to differentiate individuals who developed coronary artery disease from those who did not, based on the individuals\u27 demographic and clinical characteristics as well as their NMR findings