The atherogenic dyslipidemia of abdominal obesity is discussed in this video with two experts in this area, Drs. Philip Barter and Ronald Krauss. Dr. Barter emphasizes that abdominal obesity is now driving a new worldwide epidemic of cardiovascular disease. He invites Dr. Krauss to discuss the lipid abnormalities frequently associated with abdominal obesity. Dr. Krauss explains that small, dense LDL particles observed in abdominal obesity have a greater tendency to stick to the arteries and to be more rapidly oxidized. LDL particle size is not measured on a routine basis and can be observed even in patients who have normal LDL cholesterol levels. Fortunately, Drs. Barter and Krauss confirm that abdominal fat loss and adopting a healthier lifestyle can reverse this abnormality. Dr. Barter continues the discussion on small HDL particles that are also often observed in abdominal obesity. Moreover, he also addresses the controversy about HDL function and the evidence that patients with abdominal obesity have HDL particles that are not functioning properly. Again, a loss of abdominal fat is associated with a better function of HDL particles, along with increases in HDL cholesterol concentrations. Dr. Krauss then underlines the importance of measuring apolipoprotein B and calculating non-HDL cholesterol as LDL cholesterol does not necessarily capture the cardiovascular disease risk associated with LDL particles. Dr. Barter summarizes that instead of questioning each molecule to assess cardiovascular disease risk, physicians need to take into account the overall picture of abdominal obesity-related lipid abnormalities such as high triglycerides, small, dense LDL and low HDL concentrations.
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