LDL-cholesterol subfractions have a different atherogenity; the most atherogenic are small LDL3 called small dense LDL. A clear relationship was proved between their concentration and early manifestation of ischaemic heart disease. In some instances they were found to act as an independent risk factor of cardiovascular disease. Their concentration depends to a great extent on the triacyglycerol concentration. They are found most frequently in patients with combined hyperlipidaemia, in associated metabolic syndrome and in patients with type 2 diabetes mellitus. Their plasma concentration can be reduced by non-pharmacological methods (restriction of animal fats, reduction of body weight, physical activity) as well as by pharmacological means (in particular fibrates). Micronized phenofibrate reduces significantly the concentration of small LDL3 and thus contributes to normalization of dyslipoproteinaemia and reduction of the risk of cardiovascular complications.

Fakultní nemocnice u svaté Anny v Brnĕ Brno