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What do lipidologists think is the right LDL-P goal for our highest risk patients?  Looking at Dr. Dall's chart in Summer, 2011, Lipid Spin (p. 20) suggests a percentile equivalent goal to the NCEP, AHA, ADA  recommendation of LDL<70 would translate to to an NMR LDL-P that could be <700.   Yet I suspect that many of our clinical studies, such as TNT, indicate that the clinical benefit seen from an LDL <70 in high risk patients usually represents a discordant LDL-P of much higher value.  The improvement in clinical events comes from lowering the terrible LDL-P to one that is lower.  I think one of the chemistry/lab societies has recommended an LDL-P goal of <1100 for high risk patients.  To get all my high risk patients to an LDL-P#<700 is going to take a lot of drugs!  What say ye, Lipidologists? 

Siting Framingham Heart Study data, newly released AHA guidelines for Assessment of Cardiovascular Risk in Asymptomatic Adults does NOT recommend measurement of LDL particle number or ApoB in this group:  "Evidence that these more "advanced'  lipid measures improve predictive capacity beyond standard lipid measurements is lacking".

  Really?   Not with diabetes, metabolic syndrome, intermediate Framingham Risk score, high triglycerides, positive family history?  Never improves predictive risk capacity under any situation?  I am at a loss for words... 

  Would the NLA care to take this arguement on?  This sets my efforts to improve the insurance coverage of these tests back by 10 years.