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Atherogenic Dyslipidemia

Many practitioners have long appreciated that a significant proportion of patients with coronary artery disease (CAD) do not have marked LDL cholesterol elevations; instead, they have several risk factors which include mild LDL and triglyceride elevations, moderate HDL reductions, central obesity, mild hypertension and insulin resistance. This constellation has been called clustered risk factors, Reaven’s syndrome, the deadly quartet, syndrome X, the metabolic syndrome, or the insulin resistance syndrome.

In an effort to draw attention to the lipid profile characteristic of this common syndrome, Scott Grundy, a leading lipidologist, has coined the term “Atherogenic Dyslipidemia” (ADL). The parameters for ADL are as follows:

  • LDL-cholesterol > 130 mg/dL
  • Triglycerides > 150 mg/dL
  • HDL-cholesterol < 40 mg/dL for men & < 50 mg/dL for women

Patients with this profile also are very likely to have “small, dense LDL particles” sometimes called LDL “pattern B,” and increased levels of apolipoprotein B-100. The prevalence of the complete syndrome (all three abnormalities appearing in the same individual) is probably equal to that of isolated hypercholesterolemia (i.e., LDL-C > 160 mg/dL) which is 25-30% of the adult population.

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