Transcript LP IR Score - Lecturepad.org

Lipoprotein Insulin
Resistance Score
Thomas Dayspring, MD, FACP, FNLA, NCMP
Diplomate American Board of Clinical Lipidology
Fellow of the National Lipid Association
North American Menopause Society Certified Menopause Practitioner
Director of Cardiovascular Education The Foundation for Health
Improvement and Technology, Richmond, VA
Insulin Resistance
Lipoproteins
Lipoprotein Insulin Resistance Score
►This section includes the six lipoprotein markers
associated with insulin resistance and type 2 diabetes
risk, and are included in the calculation for the LP-IR
score.
The Lipoprotein Insulin Resistance Score (LP-IR)
assesses the patient’s insulin resistance level and T2DM
risk.
This score (0-100) is derived using the results from the
six lipoprotein markers listed.
Therapeutic lifestyle changes may reduce the score.
Genuth & Kahn. Diabetes Care 2008;31:1093-1096
www.liposcience.com
Lipoprotein Abnormalities
in Hypertriglyceridemic States
TG-rich VLDL
Apo A-V
apoC-II
apoE
apoB
Triglyceride
Cholesteryl ester
LIPOPROTEIN MARKERS ASSOCIATED
WITH INSULIN RESISTANCE1,2
Insulin Resistant
Insulin Sensitive
Percentile in Reference Population
nmol/L
LARGE VLDL-P
8.2
nmol/L
μmol/L
nm
VLDL SIZE
low
low
high
small
50.4
nm
nm
large
large
25th
50th
75th
0.8
2.4
6.4
25th
50th
75th
110
506
75th
50th
25th
7.5
4.2
3.1
25th
50th
75th
42.1
46.3
51.9
75th
50th
25th
21.1
20.8
20.4
75th
50th
25th
9.6
9.2
8.9
25th
50th
75th
high
high
808
low
large
small
small
INSULIN RESISTANCE SCORE
0-100
LP-IR SCORE**
insulin sensitive
insulin resistant
100
0
** The LP-IR SCORE combines the information from the 6 lipoprotein markers to give improved prediction of insulin resistance**
These laboratory assays validated by LipoScience have not been cleared by the US Food and Drug Administration. The clinical utility
of these laboratory values has not been fully established.
1.Garvey WT et al. Diabetes 2003;532:453-462
2. Goff DC. et al. Metabolism. 2005;54:264-270
© 2009 LipoScience, Inc. All rights reserved
Lipoprotein Abnormalities
in Hypertriglyceridemic States
TG-rich VLDL
Large LDL
CE
Apo A-V
There is now less cholesterol
per LDL & HDL particle than
previously
apoCII
(CETP)
apoE
TG
apoB
Lipoprotein Lipase
Smaller
TG-depleted,
cholesterol-rich
cholesterol-rich
VLDL
remnants
VLDL
TG-enriched
Cholesterol-depleted
particles
CE
(CETP)
LDL-C & HDL-C
TG
Large
HDL
Triglyceride
VLDL-C
Cholesteryl ester
LDL Particle Abnormalities
in Hypertriglyceridemic States
Large TG-rich LDL
TG-rich VLDL
Small LDL
CE
Hepatic
Lipase
(CETP)
TG
CE
Lipoprotein Lipase
Smaller
cholesterol-rich
VLDL remnants
(CETP)
Total LDL-P
LDL size
Small LDL-P
TG-enriched
Cholesterol-depleted
particles
TG
~ LDL-C
Large
HDL
Triglyceride
Cholesteryl ester
Framingham Offspring Study
LDL-P and Metabolic Syndrome
2000
Mean adjusted total LDL-P and LDL-C
1800
1600
High Risk
140
1400
Borderline-High Risk
LDL-C (mg/dL)
LDL-P (nmol/L)
160
120
1200
n=2993
1000
0
100
100
200
300
400
Triglycerides (mg/dL)
Kathiresan S, Otvos JD, Sullivan LM et al. Circulation. 2006;113:20-29.
LIPOPROTEIN MARKERS ASSOCIATED
WITH INSULIN RESISTANCE1,2
Insulin Resistant
Insulin Sensitive
Percentile in Reference Population
nmol/L
LARGE VLDL-P
8.2
nmol/L
SMALL LDL-P
nm
high
small
50.4
nm
LDL SIZE
low
830
μmol/L
VLDL SIZE
low
large
20.2
nm
large
25th
50th
75th
0.8
2.4
6.4
25th
50th
75th
110
506
75th
50th
25th
7.5
4.2
3.1
25th
50th
75th
42.1
46.3
51.9
75th
50th
25th
21.1
20.8
20.4
75th
50th
25th
9.6
9.2
8.9
25th
50th
75th
high
high
808
low
large
small
small
INSULIN RESISTANCE SCORE
0-100
LP-IR SCORE**
insulin sensitive
insulin resistant
100
0
** The LP-IR SCORE combines the information from the 6 lipoprotein markers to give improved prediction of insulin resistance**
These laboratory assays validated by LipoScience have not been cleared by the US Food and Drug Administration. The clinical utility
of these laboratory values has not been fully established.
1.Garvey WT et al. Diabetes 2003;532:453-462
2. Goff DC. et al. Metabolism. 2005;54:264-270
© 2009 LipoScience, Inc. All rights reserved
HDL Particle Abnormalities
in Hypertriglyceridemic States
Large TG-rich LDL
TG-rich VLDL
Small LDL
CE
Hepatic
Lipase
(CETP)
HDL-C
TG
ApoA-I
CE
Lipoprotein Lipase
Smaller
cholesterol-rich
VLDL remnants
(CETP)
TG
Hepatic
Lipase
Large
LargeTG-rich
LDL-P
HDL
Smaller HDL
HDL size
Total HDL-P
The New LipoScience Report Form
Particle Concentrations and Size
Particle Concentration and Size
Higher CVD Risk
Lower CVD Risk
LDL and HDL Particles
μmol/L
HDL-P (total)
high
28.1
nmol/L
SMALL LDL-P
Percentile in Reference Population
low
830
nm
LDL SIZE *
20.4
75th
50th
25th
35.1
30.6
26.8
25th
50th
75th
110
506
808
high
Small (Pattern B)
Large (Pattern A)
23.0
low
20.6
20.5
19.0
*Small LDL size and LDL size are associated with CVD risk, but not after LDL-P is taken into account
The particle concentration and size is now provided on a
separate report. In addition to small LDL-P (nmol/L) and LDL size
(nm), total HDL-P is reported (μmol/L).
www.liposcience.com
LIPOPROTEIN MARKERS ASSOCIATED
WITH INSULIN RESISTANCE1,2
Insulin Resistant
Insulin Sensitive
Percentile in Reference Population
nmol/L
LARGE VLDL-P
8.2
nmol/L
SMALL LDL-P
large
20.2
nm
HDL SIZE
small
50.4
nm
LDL SIZE
high
2.7
nm
VLDL SIZE
low
830
μmol/L
LARGE HDL-P
low
large
8.7
25th
50th
75th
0.8
2.4
6.4
25th
50th
75th
110
506
75th
50th
25th
7.5
4.2
3.1
25th
50th
75th
42.1
46.3
51.9
75th
50th
25th
21.1
20.8
20.4
75th
50th
25th
9.6
9.2
8.9
25th
50th
75th
high
high
808
low
large
small
small
INSULIN RESISTANCE SCORE
0-100
LP-IR SCORE**
insulin sensitive
insulin resistant
100
0
** The LP-IR SCORE combines the information from the 6 lipoprotein markers to give improved prediction of insulin resistance**
These laboratory assays validated by LipoScience have not been cleared by the US Food and Drug Administration. The clinical utility
of these laboratory values has not been fully established.
1.Garvey WT et al. Diabetes 2003;532:453-462
2. Goff DC. et al. Metabolism. 2005;54:264-270
© 2009 LipoScience, Inc. All rights reserved
LIPOPROTEIN MARKERS ASSOCIATED
WITH INSULIN RESISTANCE1,2
Insulin Resistant
Insulin Sensitive
Percentile in Reference Population
nmol/L
LARGE VLDL-P
8.2
nmol/L
SMALL LDL-P
large
20.2
nm
HDL SIZE
small
50.4
nm
LDL SIZE
high
2.7
nm
VLDL SIZE
low
830
μmol/L
LARGE HDL-P
low
large
8.7
25th
50th
75th
0.8
2.4
6.4
25th
50th
75th
110
506
75th
50th
25th
7.5
4.2
3.1
25th
50th
75th
42.1
46.3
51.9
75th
50th
25th
21.1
20.8
20.4
75th
50th
25th
9.6
9.2
8.9
25th
50th
75th
high
high
808
low
large
small
small
INSULIN RESISTANCE SCORE
0-100
LP-IR SCORE**
84
insulin sensitive
insulin resistant
100
0
** The LP-IR SCORE combines the information from the 6 lipoprotein markers to give improved prediction of insulin resistance**
These laboratory assays validated by LipoScience have not been cleared by the US Food and Drug Administration. The clinical utility
of these laboratory values has not been fully established.
1.Garvey WT et al. Diabetes 2003;532:453-462
2. Goff DC. et al. Metabolism. 2005;54:264-270
© 2009 LipoScience, Inc. All rights reserved
Labcorp Report: Insulin resistance markers
Small (Pattern) B
Large (Pattern) A
LDL particle size
Large HDL-P
Large VLDL-P
3.5
11.9
Small LDL
size
(≤ 20.5 nm)
Metabolic Syndrome Markers
20.5 – 18.0
23.0 – 20.6
19.4
3
Low Risk
Intermediate
High Risk
> 9.0
4.0-9
< 4.0
Low Risk
Intermediate
High Risk
> 0.5
0.5 – 5.0
> 5.0
Low
Large HDL-P
(< 4.0 umol/L)
3
High
Large VLDL-P
(> 5.0 nmol/L)
3
These markers increase the risk of developing Type 2 diabetes mellitus