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Background   The atherogenic lipoprotein phenotype ‘pattern B’ comprises a predominance of small-dense low-density lipoprotein (sdLDL). Gradient gel electrophoresis (GGE) is considered a ‘gold standard’ method for identifying this phenotype, but is impractical for routine laboratory use. The low-density lipoprotein cholesterol:apolipoprotein-B (LDL-C:Apo-B) ratio has been advocated as a surrogate marker for sdLDL and a direct assay for sdLDL has recently become available. We compared the sdLDL assay and LDL-C:Apo-B with more established lipid parameters to predict the presence of ‘pattern B’ phenotype.Method   Blood was collected from 97 fasted subjects on three separate occasions. Total cholesterol, triglyceride, Apo-B and sdLDL were measured; LDL- and HDL-cholesterol were determined after ultracentrifugation. The predominant LDL particle size and phenotype were assigned by GGE.Results   ‘Pattern B’ phenotype was identified in 36% of samples. Peak particle size showed a positive correlation with HDL-cholesterol and a negative correlation with triglyceride and Apo-B. Receiver operating curve (ROC) analysis showed triglyceride:HDL-C ratio and triglyceride alone to be the best predictors of ‘pattern B’ phenotype, with area under the curve (AUC) being 0.87 and 0.84, respectively. AUCs for sdLDL (0.74) and LDL-C:Apo-B (0.71) were significantly lower ( P &lt; 0.05). A high sdLDL concentration had the greatest specificity (95%) and positive predictive value (74%) for ‘pattern B’ phenotype, but low sensitivity (43%).Conclusion   Direct measurement of sdLDL provided the most specific predictor of ‘pattern B’ phenotype, whereas triglyceride:HDL-C ratio or triglycerides alone, parameters readily available in most laboratories, were the best predictors by ROC analysis.

What is the best predictor of the atherogenic LDL subclass phenotype ‘pattern B’ in patients with type 2 diabetes mellitus?