Insulin resistance, adiposity influence lipoprotein size, subclass concentrations
This study really demonstrates how behind the research most clinicians are. Just checking cholesterol really does not give us a good picture of where the patient is as far as their risk for heart disease.
This study evaluated subclasses of LDL (small, intermediate, large), VLDL (very low density lipoprotein) and HDL. Worsening insulin resistance did not affect LDL levels. However, strong changes were seen in the subclasses–decrease in the large LDL offset increases in the other sizes of LDL.
So, if one just looks at straight LDL, you just missed the fact that the real picture is one of worsening risk (larger LDL and larger HDL particles are generally considered protective). Subfractioning of the cholesterol molecules is looking more and more like a good idea…