Discordance in Lipid Measurements: Can we Capitalize to Better Personalize Cardiovascular Risk Assessment and Treatment?

Lipid measurement is one of the cornerstones of cardiovascular risk assessment and treatment. It is widely accepted that reduction of atherogenic lipids reduces risk of atherosclerotic cardiovascular disease. As the study of lipids has yielded deeper understanding of the pathophysiology of lipid metabolism, it has become clear that different techniques to quantify atherogenic lipids and lipoproteins could be complementary. For example, low-density lipoprotein cholesterol can exist in a range of forms from small, dense to large, buoyant, and therefore, discordance may arise between measures of its cholesterol content and particle concentration. In this article, we review the most recent literature on discordance in lipid measurements. We emphasize interesting and important new findings, and aim to bring the reader up-to-date on the topic. We submit that lipid discordances create an opportunity to better personalize the risk assessed for atherogenic cardiovascular disease and the care we give patients with dyslipidemia. We note that while prior research has often examined one lipid measure vs another in their abilities to predict the average risk in a population, recent studies are increasingly asking what lipid discordance in individual patients can tell us about risk. We propose that this latter approach asks the more clinically important question. The message from these studies is consistent: discordance matters. As the field moves forward, we propose standardization of methods for discordance research. In our view, this will best enable us to further clarify the clinical implications of the principle of discordance and best inform personalized cardiovascular care.