ABC | Volume 110, Nº4, April 2018

Original Article Cartolano et al LAP and lipoprotein size Arq Bras Cardiol. 2018; 110(4):339-347 Figure 2 – Percentages of large and small LDL particles and LDL size, according to the LAP tertiles. A) Adjusted by sex, age, smoking, statin, fibrate, and hypoglycemic drugs. B) Men, adjusted by age, smoking, statin, fibrate, and hypoglycemic drugs (n = 132). C) Women, adjusted by age, smoking, statin, fibrate, and hypoglycemic drugs (n = 219). i: Large LDL. ii: Small LDL. iii: LDL size. Data are presented as mean and 95% confidence interval. Comparative analysis was performed using the linear trend test. LAP tertiles: T1 ≤ 45.5; 45.5 < T2 ≤ 80.3; T3 > 80.3. HDL: high-density lipoprotein; LAP: lipid accumulation product; %: percentage Comparison between groups was performed by ANOVA or Kruskal-Wallis and multiple comparisons by Tukey test. * versus T1, § versus T2. Significance level adopted for all analysis p < 0.05. A B C i i i 30 25 20 15 8 6 4 2 0 8 10 6 4 2 0 27.5 28.0 27.0 26.5 26.0 27.5 28.0 27.0 26.5 26.0 27.5 28.0 27.0 26.5 26.0 8 10 6 4 2 0 % % nm nm nm % % % % T1 T2 T3 T1 T2 T3 T1 T2 T3 T1 T2 T3 T1 T2 T3 T1 T2 T3 T1 T2 T3 p > 0.05 p < 0.001 p < 0.001 p < 0.001 p < 0.001 p < 0.001 p < 0.001 30 35 25 20 15 30 35 25 20 15 T1 T2 T3 p < 0.001 T1 T2 T3 p > 0.05 Large LDL LAP Tercile LAP Tercile LAP Tercile LDL size Small LDL ii ii ii iii iii iii *§ *§ *§ *§ *§ *§ *§ * * * with complementary clinical and biochemical data, is the first instrument used because of its low cost. However, we admit that cardiovascular disease cannot be excluded in these individuals. And third, individuals included in this study were under statin (27.9%) and fibrate (2.6%). These drugs exert direct and indirect actions in lipid metabolism promoting changes in TG, a component of LAP. Despite that, these individuals were receiving the same drug treatment (in terms of type and posology) for at least 30 days prior to the study. Methods for the measurement of emerging cardiovascular risk factors are generally complex and expensive, and hence could not be used in large-scale studies. LAP is a low-cost, easily measured variable that could be used to establish causal effects on clinical outcomes. So, the positive results from clinical trials and prospective cohort studies using this instrument are expected to encourage new approaches to estimate CVD risk. Conclusions In conclusion, our results showed that the LAP index was associated with an atherogenic lipoprotein profile in Brazilian subjects, such as TC, HDL-C, Apo B, small HDL, small LDL and LDL size. It is plausible to suggest that the LAP may be a useful and simple clinical marker for assessment of cardiometabolic risk factors. Author contributions Conception and design of the research: Cartolano FDC, Freitas MCP, Damasceno NRT; Acquisition of data: Cartolano FDC, Pappiani C, Freitas MCP; Analysis and interpretation of the data: Cartolano FDC, Pappiani C, Figueiredo Neto AM, Carioca AAF; Statistical analysis: Cartolano FDC, Carioca AAF; Obtaining financing: Figueiredo Neto AM; Writing of the manuscript: Cartolano FDC; Critical revision of the manuscript for intellectual content: Cartolano FDC, Freitas MCP. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. 345