Letters |

Is the Size of Low-Density Lipoprotein Particles Related to the Risk of Coronary Heart Disease?—Reply

Hannia Campos, PhD; Frank M. Sacks, MD
JAMA. 2002;287(6):712-713. doi:10.1001/jama.287.6.711.
Text Size: A A A
Published online


In Reply: In response to Dr Krauss, we wish to dispel any inference from our study that small LDL is somehow benign. We judge from multiple lines of evidence that all LDL particles are atherogenic irrespective of their size. However, on a relative scale, our study shows that large LDL is more closely linked to CHD than is medium or small LDL. We found a strong linear relationship between LDL size and coronary events. We also reviewed the epidemiological literature on LDL size, and concluded that the relationship between small LDL and CHD found in some studies is probably due to its correlation with other lipoprotein risk factors. This is because small LDL has not remained a significant predictor of coronary disease after adjustment for total cholesterol and triglycerides,1 or the total to high-density lipoprotein (HDL) cholesterol ratio,2 which were significant predictors despite the inclusion of LDL size in the model. Even in the often-cited Quebec Cardiovascular Study3 also noted by Krauss, small LDL size did not contribute significantly to the risk of CHD either when analyzed as a continuous variable, or in tertiles. In fact, as stated by the authors, "apoB came out as the best and only significant predictor of [ischemic heart disease] risk in multivariate stepwise logistic analysis (P = .002)."


Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
First page PDF preview




Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.