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Nomura SO, Karger AB, Garg P, Cao J, Bhatia H, Duran EK, Duprez D, Guan W, Tsai MY. Small dense low-density lipoprotein cholesterol compared to other lipoprotein biomarkers for predicting coronary heart disease among individuals with normal fasting glucose: The Multi-Ethnic Study of Atherosclerosis. Am J Prev Cardiol 2023; 13:100436. [PMID: 36545388 PMCID: PMC9760650 DOI: 10.1016/j.ajpc.2022.100436] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 10/07/2022] [Accepted: 12/02/2022] [Indexed: 12/13/2022] Open
Abstract
Objective This study compared small dense low-density lipoprotein cholesterol (sdLDL-C) with apolipoprotein B (apo B), and low-density lipoprotein particles (LDL-P) in predicting CHD risk in generally healthy adults with normal fasting glucose (NFG). Methods This study was conducted among participants with NFG in the Multi-Ethnic Study of Atherosclerosis (MESA) prospective cohort with measurements of sdLDL-C, LDL-P, and apo B available at baseline (2000-2002) and follow-up CHD data (through 2015) (N = 3,258). Biomarkers were evaluated as quartiles, and in categories using clinically and 75th percentile-defined cut-points. Discordance/concordance of sdLDL-C relative to other biomarkers was calculated using 75th percentile cut-points and linear regression residuals. Associations between individual biomarkers, sdLDL-C discordance and CHD incidence were evaluated using Cox proportional hazards regression. Results There were 241 incident CHD events in this population through 2015. Higher sdLDL-C, apo B, LDL-P were similarly associated with increased CHD in individuals with NFG. Discordance of sdLDL-C with apo B or LDL-P by 75th percentiles was not significantly associated with CHD. Residuals discordantly higher/lower sdLDL-C relative to apo B (discordant high HR=1.26, 95% CI: 0.89, 1.78; discordant low HR=0.94, 95% CI: 0.68, 1.29) and LDL-P (discordant high HR=1.25, 95% CI: 0.88, 1.75; discordant low HR=0.84, 95% CI:0.60, 1.16), compared to those with concordant measures, had non-statistically significant higher/lower risk of CHD. Conclusions Results suggest sdLDL-C, apo B and LDL-P are generally comparable for predicting CHD events in normoglycemic individuals. Larger studies are needed to confirm findings and to investigate whether measurement of sdLDL-C may be beneficial to evaluate as an additional risk-enhancing factor.
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Affiliation(s)
- Sarah O. Nomura
- Department of Laboratory Medicine and Pathology, University of Minnesota, 420 Delaware St SE, Mayo Mail Code 609, Minneapolis, MN 55455, United States
| | - Amy B. Karger
- Department of Laboratory Medicine and Pathology, University of Minnesota, 420 Delaware St SE, Mayo Mail Code 609, Minneapolis, MN 55455, United States
| | - Parveen Garg
- Keck Medicine, University of Southern California, Los Angeles, CA, United States
| | - Jing Cao
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Harpreet Bhatia
- Division of Cardiovascular Medicine, University of California San Diego, San Diego, CA, United States
| | - Edward K. Duran
- Department of Medicine, Cardiovascular Division, University of Minnesota, Minneapolis, MN, United States
| | - Daniel Duprez
- Department of Medicine, Cardiovascular Division, University of Minnesota, Minneapolis, MN, United States
| | - Weihua Guan
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Michael Y. Tsai
- Department of Laboratory Medicine and Pathology, University of Minnesota, 420 Delaware St SE, Mayo Mail Code 609, Minneapolis, MN 55455, United States
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Sweeney T, Quispe R, Das T, Juraschek SP, Martin SS, Michos ED. The Use of Blood Biomarkers in Precision Medicine for the Primary Prevention of Atherosclerotic Cardiovascular Disease: a Review. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2021; 6:247-258. [PMID: 34423130 DOI: 10.1080/23808993.2021.1930531] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Introduction A biomarker is a substance, structure, or process that indicates the presence of a disease, infection, or environmental exposure. Clinically useful biomarkers are measurable, improve diagnostic or prognostic performance, and ultimately aid clinicians in determining the initiation, duration, or magnitude of therapy. Areas Covered The purpose of this review is to explore the roles of various blood biomarkers of atherosclerotic cardiovascular disease (ASCVD) and how their use may improve the precision with which clinicians can identify, treat, and ultimately prevent ASCVD. Our review will include lipid biomarkers, markers of cardiac injury and wall stress, markers of inflammation, and a few others. Expert Opinion Several biomarkers have recently been highlighted as "risk-enhancing factors" in the 2019 American College of Cardiology/American Heart Association Guideline for the Primary Prevention of ASCVD, which can help guide shared decision-making. These included elevated low-density lipoprotein cholesterol, triglycerides, lipoprotein(a), apolipoprotein B, or high-sensitivity C-reactive protein. However, some other biomarkers mentioned in this review are not commonly used despite showing initial promise as prognostic of ASCVD risk, as it is not clear how treatment decisions should be changed after their measurement among asymptomatic individuals. Future studies should focus on whether biomarker-directed management strategies can improve clinical outcomes.
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Affiliation(s)
- Ty Sweeney
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Renato Quispe
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Thomas Das
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Stephen P Juraschek
- Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA
| | - Seth S Martin
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Erin D Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Montero D, Dutheil F, Walther G, Perez-Martin A, Soto-Esclapez L, Vinet A, Roche E. Changes in the profile of circulating HDL subfractions in severe obese adolescents following a weight reduction program. Nutr Metab Cardiovasc Dis 2021; 31:1586-1593. [PMID: 33810960 DOI: 10.1016/j.numecd.2021.01.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 01/18/2021] [Accepted: 01/27/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND AIMS Epidemiological studies show that obese adolescents are candidates to suffer cardiovascular pathologies in adulthood. In order to detect subfractions with a diagnostic value for future cardiovascular disorders, we analyzed the complete lipoprotein profile of severely obese adolescents. METHODS AND RESULTS Twenty-eight obese adolescents free from comorbidities were admitted into a weight reduction program. Anthropometric parameters were monitored. The circulating lipoproteins and glycemia were measured at the beginning and at the end of the study by conventional blood analysis as well as by using lipoprotein electrophoresis. Twenty-one puberty-matched normal-weight adolescents were recruited as controls. After 4 months, participants improved anthropometric parameters. Blood analysis indicated that circulating lipoproteins were in the healthy range during intervention. Nevertheless, results obtained from lipoprotein electrophoresis showed a significant increase in the large high-density lipoprotein subfraction in the obese population at the end of intervention, but significantly lower than normal-weight counterparts. In addition, intermediate- and low-density lipoprotein subfractions were in the healthy range in controls and in obese adolescents during intervention. CONCLUSIONS Altogether, it seems that the obese adolescents with no comorbidities do not develop a clear dyslipidemia. However, low values of large high-density lipoprotein subfractions could be considered as candidate predictors to develop cardiovascular disease in the future. For this reason, diet and exercise are key tools to fight against this pathology. REGISTRATION NUMBER FOR CLINICAL TRIALS ISRCTN99414527.
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Affiliation(s)
- David Montero
- LaPEC, Faculty of Sciences, University of Avignon, France; Institute of Bioengineering and Department of Applied Biology-Nutrition, University Miguel Hernandez, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Frédéric Dutheil
- Laboratory of Metabolic Adaptations to Exercise in Physiological and Pathological conditions (AME2P, EA3533), Blaise Pascal University, Clermont-Ferrand, France; Sport Medicine and Functional Exploration, University Hospital CHU G. Montpied, Clermont-Ferrand, France; Occupational Medicine, University Hospital CHU G. Montpied, Clermont-Ferrand, France
| | | | | | - Laura Soto-Esclapez
- Institute of Bioengineering and Department of Applied Biology-Nutrition, University Miguel Hernandez, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Agnès Vinet
- LaPEC, Faculty of Sciences, University of Avignon, France
| | - Enrique Roche
- Institute of Bioengineering and Department of Applied Biology-Nutrition, University Miguel Hernandez, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain.
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Quispe R, Elshazly MB, Zhao D, Toth PP, Puri R, Virani SS, Blumenthal RS, Martin SS, Jones SR, Michos ED. Total cholesterol/HDL-cholesterol ratio discordance with LDL-cholesterol and non-HDL-cholesterol and incidence of atherosclerotic cardiovascular disease in primary prevention: The ARIC study. Eur J Prev Cardiol 2020; 27:1597-1605. [PMID: 31291776 PMCID: PMC6952589 DOI: 10.1177/2047487319862401] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS The total cholesterol (TC)/high-density lipoprotein (HDL) cholesterol ratio may carry additional information not available in more commonly used single cholesterol measures. Analysis of discordance between lipid parameters might help assess the impact of such additional information on the risk of atherosclerotic cardiovascular disease. We aimed to investigate the role of the TC/HDL-cholesterol ratio in determining atherosclerotic cardiovascular disease risk when discordant with low-density lipoprotein (LDL) cholesterol and non-HDL-cholesterol. METHODS We studied 14,403 Atherosclerosis Risk in Communities (ARIC) study participants who were free of atherosclerotic cardiovascular disease at baseline. TC/HDL-cholesterol discordance with LDL-cholesterol (estimated by the novel Martin/Hopkins method) and non-HDL-cholesterol was assessed at five visits and determined by being at or above the median for each lipid parameter. We constructed Cox proportional hazard models to estimate the risk for incident atherosclerotic cardiovascular disease events associated with each lipid concordance/discordance category using a time-varying approach. RESULTS Mean age of participants was 54.1 years, 56% women and 25% black. There were 2634 atherosclerotic cardiovascular disease events over a median (interquartile range) follow-up of 24.2 (16.0-25.4) years. Among individuals with LDL-cholesterol and non-HDL-cholesterol less than the median, 26% and 21% had discordant TC/HDL-cholesterol at or above the median, respectively. These individuals had a 24% (hazard ratio (HR) 1.24, 95% confidence interval (CI) 1.09, 1.41) and 29% (HR 1.29, 95% CI 1.13, 1.46) greater risk of incident atherosclerotic cardiovascular disease, respectively, compared to those with TC/HDL-cholesterol less than the median after multivariable adjustment. In individuals with diabetes with LDL-cholesterol or non-HDL-cholesterol less than the median, discordant TC/HDL-cholesterol at or above the median was more prevalent at 48% and 38%, respectively. CONCLUSION Clinically significant discordance exists between TC/HDL-cholesterol, available from the standard lipid profile, and the routinely used non-HDL-cholesterol and LDL-cholesterol. Such discordance may help inform atherosclerotic cardiovascular disease risk management, particularly in individuals with diabetes in whom discordance is more common.
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Affiliation(s)
- Renato Quispe
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Mohamed B. Elshazly
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College-Qatar, Education City, Doha, Qatar
| | - Di Zhao
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Peter P. Toth
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD
- Department of Preventive Cardiology, CGH Medical Center, Sterling, IL, and University of Illinois College of Medicine, Peoria, IL
| | - Rishi Puri
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Salim S. Virani
- Michael E. DeBakey Veterans Affairs Medical Center and Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Roger S. Blumenthal
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD
| | - Seth S. Martin
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD
| | - Steven R. Jones
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD
| | - Erin D. Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Qin P, Shi J, Cao L, Li X, Lou Y, Wang C, Ma J, Wang L, Peng X, Chen H, Xu S, Zhao P, Hu D, Hu F. Low-Density Lipoprotein Cholesterol/High-Density Lipoprotein Cholesterol Ratio and Carotid Intima-Media Thickness: A Cohort Study in China. Lipids 2020; 56:59-68. [PMID: 32856731 DOI: 10.1002/lipd.12274] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 07/19/2020] [Accepted: 07/21/2020] [Indexed: 11/10/2022]
Abstract
Low-density lipoprotein cholesterol to high-density lipoprotein cholesterol (LDL-C/HDL-C) ratio may carry additional information and has been suggested as a better predictor for atherosclerosis progression and cardiovascular disease (CVD) than LDL-C and HDL-C alone. Therefore, we aim to explore the association between LDL-C/HDL-C ratio and high carotid intima-media thickness (CIMT) risk in a large Cohort in Beijing, China. This cohort study included 13,612 adults without high CIMT at first entry and who attended the baseline examination and at least one follow-up annual examination between 2009 and 2016. We used multivariable Cox regression to estimate hazard ratios (HR) with their 95% confidence intervals (CI) for the association between LDL-C/HDL-C ratio and risk of high CIMT. During 37,912 person-years of follow-up, 1996 (1268 men and 728 women) developed high CIMT. Compared with the first quartile of LDL-C/HDL-C ratio, the risk of high CIMT was significantly increased for the fourth quartile of LDL-C/HDL-C ratio (HR = 1.51, 95% CI: 1.29-1.78). We observed a significant association between LDL-C/HDL-C ratio and high CIMT risk comparing LDL-C/HDL-C ratio >2.78 with LDL-C/HDL-C ratio ≤2.78 and significant dose-response relationship between LDL-C/HDL-C ratio and risk of high CIMT. The restricted cubic spline showed a significant nonlinear association between LDL-C/HDL-C ratio and the risk of high CIMT (pnon-linearity = 0.009). We identify a significant association between LDL-C/HDL-C ratio and the risk of high CIMT in the Chinese Cohort study. Future studies are needed to evaluate the effectiveness of reducing LDL-C/HDL-C ratio treatment on the development of high CIMT.
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Affiliation(s)
- Pei Qin
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, No.1066 Xueyuan Avenue, Nanshan District, Shenzhen, Guangdong, 518060, People's Republic of China
| | - Jing Shi
- Department of Epidemiology, College of Public Health, Harbin Medical University, No.157 Health Road, Harbin, Heilongjiang, 150000, People's Republic of China
| | - Liming Cao
- Department of Epidemiology, College of Public Health, Harbin Medical University, No.157 Health Road, Harbin, Heilongjiang, 150000, People's Republic of China
| | - Xue Li
- Department of Epidemiology, College of Public Health, Harbin Medical University, No.157 Health Road, Harbin, Heilongjiang, 150000, People's Republic of China
| | - Yanmei Lou
- Department of Health Management, Beijing Xiaotangshan Hospital, Xiaotangshan Town, Changping, Beijing, 102200, People's Republic of China
| | - Changyi Wang
- Department of Non-communicable Disease Prevention and Control, Shenzhen Nanshan Center for Chronic disease, No.7 Huaming Road, Shenzhen, Guangdong, 102200, People's Republic of China
| | - Jianping Ma
- Department of Non-communicable Disease Prevention and Control, Shenzhen Nanshan Center for Chronic disease, No.7 Huaming Road, Shenzhen, Guangdong, 102200, People's Republic of China
| | - Li Wang
- Department of Non-communicable Disease Prevention and Control, Shenzhen Nanshan Center for Chronic disease, No.7 Huaming Road, Shenzhen, Guangdong, 102200, People's Republic of China
| | - Xiaolin Peng
- Department of Non-communicable Disease Prevention and Control, Shenzhen Nanshan Center for Chronic disease, No.7 Huaming Road, Shenzhen, Guangdong, 102200, People's Republic of China
| | - Hongen Chen
- Department of Non-communicable Disease Prevention and Control, Shenzhen Nanshan Center for Chronic disease, No.7 Huaming Road, Shenzhen, Guangdong, 102200, People's Republic of China
| | - Shan Xu
- Department of Non-communicable Disease Prevention and Control, Shenzhen Nanshan Center for Chronic disease, No.7 Huaming Road, Shenzhen, Guangdong, 102200, People's Republic of China
| | - Ping Zhao
- Department of Health Management, Beijing Xiaotangshan Hospital, Xiaotangshan Town, Changping, Beijing, 102200, People's Republic of China
| | - Dongsheng Hu
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, No.1066 Xueyuan Avenue, Nanshan District, Shenzhen, Guangdong, 518060, People's Republic of China
| | - Fulan Hu
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, No.1066 Xueyuan Avenue, Nanshan District, Shenzhen, Guangdong, 518060, People's Republic of China
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Lou Y, Li X, Cao L, Qin P, Shi J, Zhang Y, Wang C, Ma J, Wang L, Peng X, Chen H, Xu S, Hu F, Zhao Y, Zhao P. LDL-cholesterol to HDL-cholesterol ratio discordance with lipid parameters and carotid intima-media thickness: a cohort study in China. Lipids Health Dis 2020; 19:141. [PMID: 32552893 PMCID: PMC7302368 DOI: 10.1186/s12944-020-01324-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 06/12/2020] [Indexed: 12/15/2022] Open
Abstract
Background The discordance of the low-density lipoprotein cholesterol-to-high-density lipoprotein cholesterol (LDL-C/HDL-C) ratio with alterative lipid parameters may explain the inconsistent association of CIMT with the LDL-C/HDL-C ratio. Therefore, this study aimed to explore the associations between LDL-C/HDL-C ratio discordance with alternative lipid parameters and elevated carotid intima-media thickness (CIMT) risk in a large cohort in Beijing, China. Methods In total, 13,612 adults who didn’t have elevated CIMT at baseline and who participated in at least one follow-up of annual examination between 2009 and 2016 were included in this cohort study. A multivariable Cox regression model was utilized to evaluate the associations of discordance of the LDL-C/HDL-C ratio with TC, TGs, LDL-C and HDL-C with elevated CIMT risk. Results During 37,999 person-years of follow-up, 2004 individuals (1274 men and 730 women) developed elevated CIMT. Among individuals with normal TC and TGs, 16.6 and 15.2% individuals had a discordantly high LDL-C/HDL-C ratio, respectively, and the risk of elevated CIMT increased by 1.54 (95% CI 1.33, 1.77) and 1.53 (95% CI 1.33, 1.76), respectively, comparing to individuals with a concordantly low LDL-C/HDL-C ratio. A high LDL-C/HDL-C ratio could significantly increase elevated CIMT risk regardless of discordance/concordance with LDL-C and HDL-C (P < 0.001). A low LDL-C/HDL-C ratio with discordantly normal HDL-C and high LDL-C (13.2% of individuals) had a 32% (HR = 1.32, 95% CI 1.11, 1.57) higher risk of elevated CIMT than concordantly low LDL-C and normal HDL-C. Sensitivity analysis by excluding CIMT developed in the first 2 years follow-up further confirmed the above results. Conclusions A high LDL-C/HDL-C ratio could significantly increase elevated CIMT risk regardless of discordance/concordance with TC, TGs, LDL-C and HDL-C Even a low LDL-C/HDL-C ratio with discordantly high LDL-C and normal HDL-C could also significantly increase CIMT risk. Individuals should maintain both the LDL-C/HDL-C ratio and LDL-C at normal levels to prevent elevated CIMT.
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Affiliation(s)
- Yanmei Lou
- Department of Health Management, Beijing Xiao Tang Shan Hospital, Beijing, People's Republic of China
| | - Xue Li
- Department of Epidemiology, College of Public Health, Harbin Medical University, Harbin, Heilongjiang, People's Republic of China
| | - Liming Cao
- Department of Epidemiology, College of Public Health, Harbin Medical University, Harbin, Heilongjiang, People's Republic of China
| | - Pei Qin
- School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
| | - Jing Shi
- Department of Epidemiology, College of Public Health, Harbin Medical University, Harbin, Heilongjiang, People's Republic of China
| | - Yanyan Zhang
- School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
| | - Changyi Wang
- Department of Non-communicable Disease Prevention and Control, Shenzhen Nanshan Center for Chronic disease, Shenzhen, Guangdong, People's Republic of China
| | - Jianping Ma
- Department of Non-communicable Disease Prevention and Control, Shenzhen Nanshan Center for Chronic disease, Shenzhen, Guangdong, People's Republic of China
| | - Li Wang
- Department of Non-communicable Disease Prevention and Control, Shenzhen Nanshan Center for Chronic disease, Shenzhen, Guangdong, People's Republic of China
| | - Xiaolin Peng
- Department of Non-communicable Disease Prevention and Control, Shenzhen Nanshan Center for Chronic disease, Shenzhen, Guangdong, People's Republic of China
| | - Hongen Chen
- Department of Non-communicable Disease Prevention and Control, Shenzhen Nanshan Center for Chronic disease, Shenzhen, Guangdong, People's Republic of China
| | - Shan Xu
- Department of Non-communicable Disease Prevention and Control, Shenzhen Nanshan Center for Chronic disease, Shenzhen, Guangdong, People's Republic of China
| | - Fulan Hu
- School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China.
| | - Yashuang Zhao
- Department of Epidemiology, College of Public Health, Harbin Medical University, Harbin, Heilongjiang, People's Republic of China.
| | - Ping Zhao
- Department of Health Management, Beijing Xiao Tang Shan Hospital, Beijing, People's Republic of China.
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Cao J, Nomura SO, Steffen BT, Guan W, Remaley AT, Karger AB, Ouyang P, Michos ED, Tsai MY. Apolipoprotein B discordance with low-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol in relation to coronary artery calcification in the Multi-Ethnic Study of Atherosclerosis (MESA). J Clin Lipidol 2020; 14:109-121.e5. [PMID: 31882375 PMCID: PMC7085429 DOI: 10.1016/j.jacl.2019.11.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 11/08/2019] [Accepted: 11/25/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Discordant levels of apolipoprotein B (apo B) relative to low-density lipoprotein cholesterol (LDL-C) or non-high-density lipoprotein cholesterol (non-HDL-C) may be associated with subclinical atherosclerotic cardiovascular disease (ASCVD). OBJECTIVE The present study investigated whether discordance between apo B and LDL-C or non-HDL-C levels was associated with subclinical ASCVD measured by coronary artery calcium (CAC). METHODS This study was conducted in a subpopulation of the Multi-Ethnic Study of Atherosclerosis (MESA) cohort, aged 45 to 84 years, free of ASCVD, and not taking lipid-lowering medications at the baseline (2000-2002) (prevalence analytic N = 4623; incidence analytic N = 2216; progression analytic N = 3947). Apo B discordance relative to LDL-C and non-HDL-C was defined using residuals and percentile rankings (>5/10/15 percentile). Associations with prevalent and incident CAC (CAC > 0 vs CAC = 0) were assessed using prevalence ratio/relative risk regression and CAC progression (absolute increase/year) using multinomial logistic regression. RESULTS Higher apo B levels were associated with CAC prevalence, incidence, and progression. Apo B discordance relative to LDL-C or non-HDL-C was inconsistently associated with CAC prevalence and progression. Discordantly high apo B relative to LDL-C and non-HDL-C was associated with CAC progression. Associations for apo B discordance with non-HDL-C remained after further adjustment for metabolic syndrome components. CONCLUSION Apo B was associated with CAC among adults aged ≥45 years not taking statins, but provided only modest additional predictive value of apo B for CAC prevalence, incidence, or progression beyond LDL-C or non-HDL-C. Apo B discordance may still be important for ASCVD risk assessment and further research is needed to confirm findings.
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Affiliation(s)
- Jing Cao
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX, USA; Department of Pathology, Texas Children's Hospital, Houston, TX, USA
| | - Sarah O Nomura
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Brian T Steffen
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Weihua Guan
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Alan T Remaley
- Lipoprotein Metabolism Section, National Heart Lung and Blood Institute, Bethesda, MD, USA
| | - Amy B Karger
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Pamela Ouyang
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael Y Tsai
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA.
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Meeusen JW, Donato LJ, Jaffe AS. Should apolipoprotein B replace LDL cholesterol as therapeutic targets are lowered? Curr Opin Lipidol 2016; 27:359-66. [PMID: 27389631 DOI: 10.1097/mol.0000000000000313] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW The success of LDL cholesterol (LDL-C) as a predictor of atherosclerotic cardiovascular disease and a therapeutic target is indisputable. Apolipoprotein B (apoB) is a more contemporary and physiologically relevant measure of atherogenic lipoproteins. This report summarizes recent comparisons of apoB and LDL-C as biomarkers of cardiovascular risk. RECENT FINDINGS Multiple recent reports have found that LDL-C methods perform poorly at low concentrations (<70 mg/dl). Several meta-analyses from randomized controlled trials and large prospective observational studies have found that apoB and LDL-C provide equivalent information on risk of cardiovascular disease. More innovative analyses have asserted that apoB is a superior indicator of actual risk when apoB and LDL-C disagree. SUMMARY ApoB is more analytically robust and standardized biomarker than LDL-C. Large population studies have found that apoB is at worst clinically equivalent to LDL-C and likely superior when disagreement exists. Realistically, many obstacles prevent the wide spread adoption of apoB and for now providers and their patients must weigh the costs and benefits of apoB.
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Affiliation(s)
- Jeffrey W Meeusen
- aDepartment of Laboratory Medicine and PathologybDepartment of Cardiology, Mayo Clinic, Rochester, Minnesota, USA
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Moriyama K, Takahashi E. Non-HDL Cholesterol is a More Superior Predictor of Small-Dense LDL Cholesterol than LDL Cholesterol in Japanese Subjects with TG Levels <400 mg/dL. J Atheroscler Thromb 2016; 23:1126-37. [PMID: 27001003 PMCID: PMC5090818 DOI: 10.5551/jat.33985] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Aim: The Japan Atherosclerosis Society (JAS) guidelines for the diagnosis and treatment of hyperlipidemia in Japanese adults recommend using low-density lipoprotein cholesterol (LDL-C) calculated by Friedewald formula (F_LDL-C) for subjects with triglyceride (TG) levels <400 mg/dL and non-high-density lipoprotein cholesterol (non-HDL-C) levels for subjects with TG levels ≥400 mg/dL. Because small-dense LDL particles are more atherogenic than large LDL particles, we sought the better lipid parameter which was more reflective of the high small-dense LDL-C (sdLDL-C) levels in subjects with TG levels <400 mg/dL. Methods: This study included 769 Japanese subjects who met our inclusion criteria and underwent an annual health examination, including sdLDL-C analyses. Results: The correlation coefficient of non-HDL-C for sdLDL-C (r = 0.760) was significantly higher than that of F_LDL-C (r = 0.601). The area under the curve (95% confidence interval) was 0.771 (0.731, 0.811) for F_LDL-C and 0.871 (0.842, 0.901) for non HDL-C, which showed significantly higher predictive value for more than fourth quartile value of sdLDL-C (46 mg/dL). The optimal cut-off point of non-HDL-C was 158 mg/dL. Even in subjects stratified by waist circumstance, homeostasis model assessment of insulin resistance, TG, and F_LDL-C levels and non-HDL-C showed stronger relationships with sdLDL-C than F_LDL-C. Moreover, non-HDL-C showed a better relationship with sdLDL-C than total cholesterol (TC), TC/HDL-C, and non-HDL-C/HDL-C. Conclusion: Our data suggested that non-HDL-C is superior to F_LDL-C and one of the reliable surrogate lipid markers of sdLDL-C in Japanese subjects with TG levels <400 mg/dL.
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Affiliation(s)
- Kengo Moriyama
- Department of Clinical Health Science, Tokai University School of Medicine, Tokyo, Japan
| | - Eiko Takahashi
- Department of Clinical Health Science, Tokai University School of Medicine, Tokyo, Japan
- Address for correspondence: Eiko Takahashi, Department of Clinical Health Science, Tokai University School of Medicine, 1838 Ishikawa-machi, Hachioji, Tokyo 192-0032, Japan (Health Evaluation and Promotion Center, Tokai University Hachioji Hospital) E-mail:
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10
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Bays HE. A lipidologist perspective of global lipid guidelines and recommendations, part 1: Lipid treatment targets and risk assessment. J Clin Lipidol 2016; 10:228-39. [DOI: 10.1016/j.jacl.2015.10.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 09/14/2015] [Accepted: 10/16/2015] [Indexed: 11/15/2022]
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11
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Bjornstad P, Eckel RH, Pyle L, Rewers M, Maahs DM, Snell-Bergeon JK. Relation of Combined Non-High-Density Lipoprotein Cholesterol and Apolipoprotein B With Atherosclerosis in Adults With Type 1 Diabetes Mellitus. Am J Cardiol 2015; 116:1057-62. [PMID: 26251001 DOI: 10.1016/j.amjcard.2015.07.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 07/03/2015] [Accepted: 07/03/2015] [Indexed: 11/26/2022]
Abstract
Apolipoprotein B (apoB) and non-high-density lipoprotein cholesterol (non-HDL-C) are cardiovascular disease risk markers, although data in adults with type 1 diabetes mellitus (DM) are limited. We hypothesized that elevated apoB and non-HDL-C would be associated with greater odds of coronary artery calcification progression (CACp), a measure of coronary atherosclerosis, than either category alone in adults with type 1 DM. We grouped subjects with type 1 DM (n = 652) into 4 groups: elevated apoB (≥90 mg/dl) and elevated non-HDL-C (≥130 mg/dl), elevated non-HDL-C alone, elevated apoB alone, and normal apoB and non-HDL-C. We used logistic regression to examine the associations between the groups and CACp for a period of 6 years. We performed sensitivity analyses with elevated apoB and non-HDL-C redefined as at or more than the cohort means (91.4 and 119.0 mg/dl, respectively). Subjects with elevated apoB and non-HDL-C had greater odds of CACp compared with those with normal apoB and non-HDL-C (odds ratio 1.90, 95% confidence interval 1.15 to 3.15) and compared with subjects with elevated apoB alone (odds ratio 2.86, 95% confidence interval 1.43 to 5.74) adjusting for age, gender, duration, hemoglobin A1c, and statins. Similar results were obtained with elevated apoB and non-HDL-C defined as at or more than the cohort means. In conclusion, elevated apoB and non-HDL-C carry a greater risk of atherosclerosis than elevated apoB in the absence of elevated non-HDL-C in adults with type 1 DM. These data suggest that apoB and non-HDL-C should be viewed as complementary rather than competitive indexes of cardiovascular disease risk in type 1 DM.
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12
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Mora S, Caulfield MP, Wohlgemuth J, Chen Z, Superko HR, Rowland CM, Glynn RJ, Ridker PM, Krauss RM. Atherogenic Lipoprotein Subfractions Determined by Ion Mobility and First Cardiovascular Events After Random Allocation to High-Intensity Statin or Placebo: The Justification for the Use of Statins in Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER) Trial. Circulation 2015; 132:2220-9. [PMID: 26408274 DOI: 10.1161/circulationaha.115.016857] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 09/16/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cardiovascular disease (CVD) can occur in individuals with low low-density lipoprotein (LDL) cholesterol (LDL-C). We investigated whether detailed measures of LDL subfractions and other lipoproteins can be used to assess CVD risk in a population with both low LDL-C and high C-reactive protein who were randomized to high-intensity statin or placebo. METHODS AND RESULTS In 11 186 Justification for the Use of Statins in Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER) participants, we tested whether lipids, apolipoproteins, and ion mobility-measured particle concentrations at baseline and after random allocation to rosuvastatin 20 mg/d or placebo were associated with first CVD events (n=307) or CVD/all-cause death (n=522). In placebo-allocated participants, baseline LDL-C was not associated with CVD (adjusted hazard ratio [HR] per SD, 1.03; 95% confidence interval [CI], 0.88-1.21). In contrast, associations with CVD events were observed for baseline non-high-density lipoprotein (HDL) cholesterol (HR, 1.18; 95% CI, 1.01-1.38), apolipoprotein B (HR, 1.28; 95% CI, 1.11-1.48), and ion mobility-measured non-HDL particles (HR, 1.19; 95% CI, 1.05-1.35) and LDL particles (HR, 1.21; 95% CI, 1.07-1.37). Association with CVD events was also observed for several LDL and very-low-density lipoprotein subfractions but not for ion mobility-measured HDL subfractions. In statin-allocated participants, CVD events were associated with on-treatment LDL-C, non-HDL cholesterol, and apolipoprotein B; these were also associated with CVD/all-cause death, as were several LDL and very-low-density lipoprotein subfractions, albeit with a pattern of association that differed from the baseline risk. CONCLUSIONS In JUPITER, baseline LDL-C was not associated with CVD events, in contrast with significant associations for non-HDL cholesterol and atherogenic particles: apolipoprotein B and ion mobility-measured non-HDL particles, LDL particles, and select subfractions of very-low-density lipoprotein particles and LDL particles. During high-intensity statin therapy, on-treatment levels of LDL-C and atherogenic particles were associated with residual risk of CVD/all-cause death. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00239681.
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Affiliation(s)
- Samia Mora
- From the Divisions of Preventive (S.M., R.J.G., P.MR.) and Cardiovascular Medicine (S.M., P.MR.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Quest Diagnostics, Alameda, CA (M.P.C., J.W., Z.C., C.M.R.); Cholesterol, Genetics, and Heart Disease Institute, Carmel, CA (H.R.S.); and Children's Hospital Oakland Research Institute, Oakland, CA (R.M.K.).
| | - Michael P Caulfield
- From the Divisions of Preventive (S.M., R.J.G., P.MR.) and Cardiovascular Medicine (S.M., P.MR.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Quest Diagnostics, Alameda, CA (M.P.C., J.W., Z.C., C.M.R.); Cholesterol, Genetics, and Heart Disease Institute, Carmel, CA (H.R.S.); and Children's Hospital Oakland Research Institute, Oakland, CA (R.M.K.)
| | - Jay Wohlgemuth
- From the Divisions of Preventive (S.M., R.J.G., P.MR.) and Cardiovascular Medicine (S.M., P.MR.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Quest Diagnostics, Alameda, CA (M.P.C., J.W., Z.C., C.M.R.); Cholesterol, Genetics, and Heart Disease Institute, Carmel, CA (H.R.S.); and Children's Hospital Oakland Research Institute, Oakland, CA (R.M.K.)
| | - Zhihong Chen
- From the Divisions of Preventive (S.M., R.J.G., P.MR.) and Cardiovascular Medicine (S.M., P.MR.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Quest Diagnostics, Alameda, CA (M.P.C., J.W., Z.C., C.M.R.); Cholesterol, Genetics, and Heart Disease Institute, Carmel, CA (H.R.S.); and Children's Hospital Oakland Research Institute, Oakland, CA (R.M.K.)
| | - H Robert Superko
- From the Divisions of Preventive (S.M., R.J.G., P.MR.) and Cardiovascular Medicine (S.M., P.MR.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Quest Diagnostics, Alameda, CA (M.P.C., J.W., Z.C., C.M.R.); Cholesterol, Genetics, and Heart Disease Institute, Carmel, CA (H.R.S.); and Children's Hospital Oakland Research Institute, Oakland, CA (R.M.K.)
| | - Charles M Rowland
- From the Divisions of Preventive (S.M., R.J.G., P.MR.) and Cardiovascular Medicine (S.M., P.MR.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Quest Diagnostics, Alameda, CA (M.P.C., J.W., Z.C., C.M.R.); Cholesterol, Genetics, and Heart Disease Institute, Carmel, CA (H.R.S.); and Children's Hospital Oakland Research Institute, Oakland, CA (R.M.K.)
| | - Robert J Glynn
- From the Divisions of Preventive (S.M., R.J.G., P.MR.) and Cardiovascular Medicine (S.M., P.MR.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Quest Diagnostics, Alameda, CA (M.P.C., J.W., Z.C., C.M.R.); Cholesterol, Genetics, and Heart Disease Institute, Carmel, CA (H.R.S.); and Children's Hospital Oakland Research Institute, Oakland, CA (R.M.K.)
| | - Paul M Ridker
- From the Divisions of Preventive (S.M., R.J.G., P.MR.) and Cardiovascular Medicine (S.M., P.MR.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Quest Diagnostics, Alameda, CA (M.P.C., J.W., Z.C., C.M.R.); Cholesterol, Genetics, and Heart Disease Institute, Carmel, CA (H.R.S.); and Children's Hospital Oakland Research Institute, Oakland, CA (R.M.K.)
| | - Ronald M Krauss
- From the Divisions of Preventive (S.M., R.J.G., P.MR.) and Cardiovascular Medicine (S.M., P.MR.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Quest Diagnostics, Alameda, CA (M.P.C., J.W., Z.C., C.M.R.); Cholesterol, Genetics, and Heart Disease Institute, Carmel, CA (H.R.S.); and Children's Hospital Oakland Research Institute, Oakland, CA (R.M.K.)
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13
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Elshazly MB, Quispe R, Michos ED, Sniderman AD, Toth PP, Banach M, Kulkarni KR, Coresh J, Blumenthal RS, Jones SR, Martin SS. Patient-Level Discordance in Population Percentiles of the Total Cholesterol to High-Density Lipoprotein Cholesterol Ratio in Comparison With Low-Density Lipoprotein Cholesterol and Non-High-Density Lipoprotein Cholesterol: The Very Large Database of Lipids Study (VLDL-2B). Circulation 2015; 132:667-76. [PMID: 26137953 PMCID: PMC4550508 DOI: 10.1161/circulationaha.115.016163] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 06/18/2015] [Indexed: 01/24/2023]
Abstract
BACKGROUND The total cholesterol to high-density lipoprotein cholesterol (TC/HDL-C) ratio, estimated low-density lipoprotein cholesterol (LDL-C), and non-HDL-C are routinely available from the standard lipid profile. We aimed to assess the extent of patient-level discordance of TC/HDL-C with LDL-C and non-HDL-C, because discordance suggests the possibility of additional information. METHODS AND RESULTS We compared population percentiles of TC/HDL-C, Friedewald-estimated LDL-C, and non-HDL-C in 1 310 432 US adults from the Very Large Database of Lipids. Lipid testing was performed by ultracentrifugation (Vertical Auto Profile, Atherotech, AL). One in 3 patients had ≥25 percentile units discordance between TC/HDL-C and LDL-C, whereas 1 in 4 had ≥25 percentile units discordance between TC/HDL-C and non-HDL-C. The proportion of patients with TC/HDL-C > LDL-C by ≥25 percentile units increased from 3% at triglycerides <100 mg/dL to 51% at triglycerides 200 to 399 mg/dL. On a smaller scale, TC/HDL-C > non-HDL-C discordance by ≥25 percentile units increased from 6% to 21%. In those with <15th percentile levels of LDL-C (<70 mg/dL) or non-HDL-C (<93 mg/dL), a respective 58% and 46% were above the percentile-equivalent TC/HDL-C of 2.6. Age, sex, and directly measured components of the standard lipid profile explained >86% of the variance in percentile discordance between TC/HDL-C versus LDL-C and non-HDL-C. CONCLUSIONS In this contemporary, cross-sectional, big data analysis of US adults who underwent advanced lipid testing, the extent of patient-level discordance suggests that TC/HDL-C may offer potential additional information to LDL-C and non-HDL-C. Future studies are required to determine the clinical implications of this observation. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01698489.
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Affiliation(s)
- Mohamed B Elshazly
- From Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (M.B.E., R.Q.,E.D.M., P.P.T., R.S.B., S.R.J., S.S.M.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (M.B.E.); Welch Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (E.D.M., J.C., S.S.M.); Mike Rosenbloom Laboratory for Cardiovascular Research, McGill University Health Centre, Montreal, Quebec, Canada (A.D.S.); Department of Preventive Cardiology, CGH Medical Center, Sterling, IL, and University of Illinois College of Medicine, Peoria (P.P.T.); Department of Hypertension, Medical University of Lodz, Poland (M.B.); and Atherotech Diagnostics Laboratory, Birmingham, AL (K.R.K.).
| | - Renato Quispe
- From Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (M.B.E., R.Q.,E.D.M., P.P.T., R.S.B., S.R.J., S.S.M.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (M.B.E.); Welch Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (E.D.M., J.C., S.S.M.); Mike Rosenbloom Laboratory for Cardiovascular Research, McGill University Health Centre, Montreal, Quebec, Canada (A.D.S.); Department of Preventive Cardiology, CGH Medical Center, Sterling, IL, and University of Illinois College of Medicine, Peoria (P.P.T.); Department of Hypertension, Medical University of Lodz, Poland (M.B.); and Atherotech Diagnostics Laboratory, Birmingham, AL (K.R.K.)
| | - Erin D Michos
- From Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (M.B.E., R.Q.,E.D.M., P.P.T., R.S.B., S.R.J., S.S.M.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (M.B.E.); Welch Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (E.D.M., J.C., S.S.M.); Mike Rosenbloom Laboratory for Cardiovascular Research, McGill University Health Centre, Montreal, Quebec, Canada (A.D.S.); Department of Preventive Cardiology, CGH Medical Center, Sterling, IL, and University of Illinois College of Medicine, Peoria (P.P.T.); Department of Hypertension, Medical University of Lodz, Poland (M.B.); and Atherotech Diagnostics Laboratory, Birmingham, AL (K.R.K.)
| | - Allan D Sniderman
- From Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (M.B.E., R.Q.,E.D.M., P.P.T., R.S.B., S.R.J., S.S.M.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (M.B.E.); Welch Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (E.D.M., J.C., S.S.M.); Mike Rosenbloom Laboratory for Cardiovascular Research, McGill University Health Centre, Montreal, Quebec, Canada (A.D.S.); Department of Preventive Cardiology, CGH Medical Center, Sterling, IL, and University of Illinois College of Medicine, Peoria (P.P.T.); Department of Hypertension, Medical University of Lodz, Poland (M.B.); and Atherotech Diagnostics Laboratory, Birmingham, AL (K.R.K.)
| | - Peter P Toth
- From Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (M.B.E., R.Q.,E.D.M., P.P.T., R.S.B., S.R.J., S.S.M.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (M.B.E.); Welch Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (E.D.M., J.C., S.S.M.); Mike Rosenbloom Laboratory for Cardiovascular Research, McGill University Health Centre, Montreal, Quebec, Canada (A.D.S.); Department of Preventive Cardiology, CGH Medical Center, Sterling, IL, and University of Illinois College of Medicine, Peoria (P.P.T.); Department of Hypertension, Medical University of Lodz, Poland (M.B.); and Atherotech Diagnostics Laboratory, Birmingham, AL (K.R.K.)
| | - Maciej Banach
- From Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (M.B.E., R.Q.,E.D.M., P.P.T., R.S.B., S.R.J., S.S.M.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (M.B.E.); Welch Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (E.D.M., J.C., S.S.M.); Mike Rosenbloom Laboratory for Cardiovascular Research, McGill University Health Centre, Montreal, Quebec, Canada (A.D.S.); Department of Preventive Cardiology, CGH Medical Center, Sterling, IL, and University of Illinois College of Medicine, Peoria (P.P.T.); Department of Hypertension, Medical University of Lodz, Poland (M.B.); and Atherotech Diagnostics Laboratory, Birmingham, AL (K.R.K.)
| | - Krishnaji R Kulkarni
- From Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (M.B.E., R.Q.,E.D.M., P.P.T., R.S.B., S.R.J., S.S.M.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (M.B.E.); Welch Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (E.D.M., J.C., S.S.M.); Mike Rosenbloom Laboratory for Cardiovascular Research, McGill University Health Centre, Montreal, Quebec, Canada (A.D.S.); Department of Preventive Cardiology, CGH Medical Center, Sterling, IL, and University of Illinois College of Medicine, Peoria (P.P.T.); Department of Hypertension, Medical University of Lodz, Poland (M.B.); and Atherotech Diagnostics Laboratory, Birmingham, AL (K.R.K.)
| | - Josef Coresh
- From Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (M.B.E., R.Q.,E.D.M., P.P.T., R.S.B., S.R.J., S.S.M.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (M.B.E.); Welch Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (E.D.M., J.C., S.S.M.); Mike Rosenbloom Laboratory for Cardiovascular Research, McGill University Health Centre, Montreal, Quebec, Canada (A.D.S.); Department of Preventive Cardiology, CGH Medical Center, Sterling, IL, and University of Illinois College of Medicine, Peoria (P.P.T.); Department of Hypertension, Medical University of Lodz, Poland (M.B.); and Atherotech Diagnostics Laboratory, Birmingham, AL (K.R.K.)
| | - Roger S Blumenthal
- From Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (M.B.E., R.Q.,E.D.M., P.P.T., R.S.B., S.R.J., S.S.M.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (M.B.E.); Welch Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (E.D.M., J.C., S.S.M.); Mike Rosenbloom Laboratory for Cardiovascular Research, McGill University Health Centre, Montreal, Quebec, Canada (A.D.S.); Department of Preventive Cardiology, CGH Medical Center, Sterling, IL, and University of Illinois College of Medicine, Peoria (P.P.T.); Department of Hypertension, Medical University of Lodz, Poland (M.B.); and Atherotech Diagnostics Laboratory, Birmingham, AL (K.R.K.)
| | - Steven R Jones
- From Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (M.B.E., R.Q.,E.D.M., P.P.T., R.S.B., S.R.J., S.S.M.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (M.B.E.); Welch Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (E.D.M., J.C., S.S.M.); Mike Rosenbloom Laboratory for Cardiovascular Research, McGill University Health Centre, Montreal, Quebec, Canada (A.D.S.); Department of Preventive Cardiology, CGH Medical Center, Sterling, IL, and University of Illinois College of Medicine, Peoria (P.P.T.); Department of Hypertension, Medical University of Lodz, Poland (M.B.); and Atherotech Diagnostics Laboratory, Birmingham, AL (K.R.K.)
| | - Seth S Martin
- From Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (M.B.E., R.Q.,E.D.M., P.P.T., R.S.B., S.R.J., S.S.M.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (M.B.E.); Welch Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (E.D.M., J.C., S.S.M.); Mike Rosenbloom Laboratory for Cardiovascular Research, McGill University Health Centre, Montreal, Quebec, Canada (A.D.S.); Department of Preventive Cardiology, CGH Medical Center, Sterling, IL, and University of Illinois College of Medicine, Peoria (P.P.T.); Department of Hypertension, Medical University of Lodz, Poland (M.B.); and Atherotech Diagnostics Laboratory, Birmingham, AL (K.R.K.)
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14
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Bjornstad P, Nguyen N, Reinick C, Maahs DM, Bishop FK, Clements SA, Snell-Bergeon JK, Lieberman R, Pyle L, Daniels SR, Paul Wadwa R. Association of apolipoprotein B, LDL-C and vascular stiffness in adolescents with type 1 diabetes. Acta Diabetol 2015; 52:611-9. [PMID: 25539881 PMCID: PMC4449793 DOI: 10.1007/s00592-014-0693-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 12/01/2014] [Indexed: 10/24/2022]
Abstract
AIMS LDL cholesterol (LDL-C) is the current lipid standard for cardiovascular disease (CVD)-risk assessment in type 1 diabetes. Apolipoprotein B (apoB) may be helpful to further stratify CVD risk. We explored the association between apoB and pulse wave velocity (PWV) to determine if apoB would improve CVD-risk stratification, especially in type 1 diabetes adolescents with borderline LDL-C (100-129 mg/dL). We hypothesized that type 1 diabetes adolescents with borderline LDL-C and elevated apoB (≥90 mg/dL) would have increased PWV compared to those with borderline LDL-C and normal apoB (<90 mg/dL), and that apoB would explain more of the variability of PWV than alternative lipid indices. METHODS Fasting lipids, including apoB, were collected in 267 adolescents, age 12-19 years, with diabetes duration >5 years and HbA1c 8.9 ± 1.6 %. Triglyceride to HDL-C ratio (TG/HDL-C) and nonHDL-cholesterol (nonHDL-C) were calculated. PWV was measured in the carotid-femoral segment. RESULTS ApoB, nonHDL-C and TG/HDL-C correlated with PWV (p < 0.0001). ApoB, nonHDL-C and TG/HDL-C remained significantly associated with PWV in fully adjusted models. In adolescents with borderline LDL-C (n = 61), PWV was significantly higher in those with elevated apoB than in those with normal apoB (5.6 ± 0.6 vs. 5.2 ± 0.6 m/s, p < 0.01) and also remained significant after adjustment for CVD-risk factors (p = 0.0002). Moreover, in those with borderline LDL-C, apoB explained more of the variability of PWV than nonHDL-C and TG/HDL-C. CONCLUSION Elevated apoB is associated with increased arterial stiffness in type 1 diabetes adolescents. Measurement of apoB in addition to LDL-C may be helpful in stratifying CVD risk in type 1 diabetes adolescents, especially in those with borderline LDL-C.
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Affiliation(s)
- Petter Bjornstad
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA,
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15
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Cainzos-Achirica M, Eissler K, Blaha MJ, Blumenthal RS, Martin SS. Tools for Cardiovascular Risk Assessment in Clinical Practice. CURRENT CARDIOVASCULAR RISK REPORTS 2015. [DOI: 10.1007/s12170-015-0455-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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16
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Jacobson TA, Ito MK, Maki KC, Orringer CE, Bays HE, Jones PH, McKenney JM, Grundy SM, Gill EA, Wild RA, Wilson DP, Brown WV. National lipid association recommendations for patient-centered management of dyslipidemia: part 1--full report. J Clin Lipidol 2015; 9:129-69. [PMID: 25911072 DOI: 10.1016/j.jacl.2015.02.003] [Citation(s) in RCA: 539] [Impact Index Per Article: 59.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 02/09/2015] [Indexed: 02/07/2023]
Abstract
The leadership of the National Lipid Association convened an Expert Panel to develop a consensus set of recommendations for patient-centered management of dyslipidemia in clinical medicine. An Executive Summary of those recommendations was previously published. This document provides support for the recommendations outlined in the Executive Summary. The major conclusions include (1) an elevated level of cholesterol carried by circulating apolipoprotein B-containing lipoproteins (non-high-density lipoprotein cholesterol and low-density lipoprotein cholesterol [LDL-C], termed atherogenic cholesterol) is a root cause of atherosclerosis, the key underlying process contributing to most clinical atherosclerotic cardiovascular disease (ASCVD) events; (2) reducing elevated levels of atherogenic cholesterol will lower ASCVD risk in proportion to the extent that atherogenic cholesterol is reduced. This benefit is presumed to result from atherogenic cholesterol lowering through multiple modalities, including lifestyle and drug therapies; (3) the intensity of risk-reduction therapy should generally be adjusted to the patient's absolute risk for an ASCVD event; (4) atherosclerosis is a process that often begins early in life and progresses for decades before resulting a clinical ASCVD event. Therefore, both intermediate-term and long-term or lifetime risk should be considered when assessing the potential benefits and hazards of risk-reduction therapies; (5) for patients in whom lipid-lowering drug therapy is indicated, statin treatment is the primary modality for reducing ASCVD risk; (6) nonlipid ASCVD risk factors should also be managed appropriately, particularly high blood pressure, cigarette smoking, and diabetes mellitus; and (7) the measurement and monitoring of atherogenic cholesterol levels remain an important part of a comprehensive ASCVD prevention strategy.
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Affiliation(s)
- Terry A Jacobson
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
| | - Matthew K Ito
- Oregon State University/Oregon Health & Science University, College of Pharmacy, Portland, OR, USA
| | - Kevin C Maki
- Midwest Center for Metabolic & Cardiovascular Research and DePaul University, Chicago, IL, USA
| | | | - Harold E Bays
- Louisville Metabolic and Atherosclerosis Research Center, Louisville, KY, USA
| | | | - James M McKenney
- Virginia Commonwealth University and National Clinical Research, Richmond, VA, USA
| | - Scott M Grundy
- The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Edward A Gill
- University of Washington/Harborview Medical Center, Seattle, WA, USA
| | - Robert A Wild
- Oklahoma University Health Sciences Center, Oklahoma City, OK, USA
| | - Don P Wilson
- Cook Children's Medical Center, Fort Worth, TX, USA
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Sniderman AD, Lamarche B, Contois JH, de Graaf J. Discordance analysis and the Gordian Knot of LDL and non-HDL cholesterol versus apoB. Curr Opin Lipidol 2014; 25:461-7. [PMID: 25340478 DOI: 10.1097/mol.0000000000000127] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Conventional methods, comparing the concentration of cholesterol to particle number as indices of cardiovascular risk, have not produced consistent results, in large part, because they treat these variables as independent and unrelated. However, although highly correlated, apolipoprotein B particles may contain a normal mass of cholesterol or may be cholesterol-depleted or cholesterol-enriched. Discordance analysis compares the predictive power of LDL-C and non-HDL-C to apolipoprotein B and LDL particle numbers in patients in whom they differ, that is, in whom they are discordant. The advantage of discordance analysis is that the results are not diluted by concordant data in which risk predictions cannot differ. RECENT FINDINGS The evidence, to date, consistently demonstrates that apolipoprotein B and LDL particle numbers are more accurate indices of cardiovascular risk than LDL-C or non-HDL-C. SUMMARY Discordance analysis is a methodological advance that allows the clinical value of closely correlated variables to be determined and demonstrates that cardiovascular risk is more closely related to the number of atherogenic particles than to the total mass of cholesterol within them.
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Affiliation(s)
- Allan D Sniderman
- aMike Rosenbloom Laboratory for Cardiovascular Research, McGill University Health Centre, Royal Victoria Hospital, Montreal bInstitute of Nutrition and Functional Foods, Laval University, Hochelaga, Quebec, Canada cSun Diagnostics, LLC, New Gloucester, Maine, USA dDepartment of Internal Medicine, Division of Vascular Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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Cruz DE, Ahmed HM, Jones SR, Elshazly MB, Martin SS. Discordance in Lipid Measurements: Can we Capitalize to Better Personalize Cardiovascular Risk Assessment and Treatment? CURRENT CARDIOVASCULAR RISK REPORTS 2014. [DOI: 10.1007/s12170-014-0382-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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