Growing Cardiovascular and Metabolic Diseases in the Developing Countries: Is there a Role for Small Dense LDL Particles as an Inclusion Criteria for Individuals at Risk for the Metabolic Syndrome?

The prevalence of the metabolic syndrome is significant in nations with developed economies and is growing in countries with rapidly growing economies. The reasons for this are complex but include increased availability to cheaper (and less nutritious) food and increased mechanization. This results in reduced physical activity and an increase in total body fat and weight. Current inclusion criteria for the metabolic syndrome include parameters of obesity, elevated blood glucose, elevated triglycerides, and low HDL cholesterol. However, with the increased information regarding LDL (and specifically the small dense LDL particle) as a major risk factor for cardiovascular disease, no present consideration for LDL cholesterol as inclusion criteria for the metabolic syndrome is made. This article explores the role of LDL cholesterol as a cause and effect of complications with the metabolic syndrome in patients of these countries that are developing cardiovascular and metabolic diseases at an accelerated rate. Furthermore, as measurement of small dense LDL and apoprotein components becomes more widely available and cost effective, it may be that evaluation of these parameters and markers will assist the clinician and high-risk patient in the management and treatment of conditions that are associated with the metabolic syndrome.