Dobiásová 2004: Atherogenic Index of Plasma - Theoretical and Practical Implications

Background

Dr. Milada Dobiášová (Czech Academy of Sciences) and Dr. Jiri Frohlich (University of British Columbia) published this foundational paper on the Atherogenic Index of Plasma in Clinical Chemistry (PMID: 15165561).

Study Design

Review combining mathematical modeling with clinical data to validate log(TG/HDL-C) as a marker of LDL particle size and cardiovascular risk.

Key Findings

Correlation with LDL particle diameter:

• •AIP vs. LDL diameter: r = −0.803 (p < 0.001)
• •Higher AIP = smaller, denser LDL particles

AIP risk categories:

AIP Value	Risk Level	LDL Phenotype
< 0.11	Low	Large, buoyant (Pattern A)
0.11-0.21	Intermediate	Mixed
> 0.21	High	Small, dense (Pattern B)

Practical advantage: AIP calculated from routine lipid panel; no expensive particle testing needed.

Mechanistic Insights

The TG/HDL ratio reflects:

1. •VLDL overproduction (insulin resistance marker)
2. •Enhanced cholesteryl ester transfer protein (CETP) activity
3. •Hepatic lipase activity affecting LDL remodeling

These interconnected processes result in the atherogenic lipid triad: high TG, low HDL, small dense LDL.

Clinical Implications

AIP provides actionable insight from standard lipid panels. Patients with "normal" LDL but high AIP have elevated cardiovascular risk. AIP responds to dietary carbohydrate restriction more than to low-fat diets.

Metabolic Health Perspective

AIP is a superior marker of cardiometabolic risk than LDL-C alone. Its strong correlation with insulin resistance makes it valuable for metabolic optimization monitoring. Target: AIP < 0.11.