TY - JOUR
T1 - Non-high-density lipoprotein cholesterol, guideline targets, and population percentiles for secondary prevention in 1.3 million adults
T2 - The VLDL-2 study (very large database of lipids)
AU - Elshazly, Mohamed B.
AU - Martin, Seth S.
AU - Blaha, Michael J.
AU - Joshi, Parag H.
AU - Toth, Peter P.
AU - McEvoy, John W.
AU - Al-Hijji, Mohammed A.
AU - Kulkarni, Krishnaji R.
AU - Kwiterovich, Peter O.
AU - Blumenthal, Roger S.
AU - Jones, Steven R.
N1 - Funding Information:
Atherotech provided the investigators with de-identified data generated from commercial lipid analyses and did not provide payments for the research or manuscript writing and did not participate in data analysis or influence the conclusions. This study was initiated by the investigators and did not receive any specific funding. Drs. Martin, McEvoy, and Joshi are supported by the Pollin Fellowship in Preventive Cardiology. Dr. Martin is supported by the Marie-Josée and Henry R. Kravis endowed fellowship. Dr. Toth is a consultant for Atherotech Diagnostics Lab, Amgen, Genzyme, Kowa, Boehringer Ingelheim, Liposcience, and Merck; and is a member of the speaker's bureau for AstraZeneca, Amarin, GlaxoSmithKline, Kowa, Merck & Co., and Genzyme. Dr. Kulkarni is a research director at Atherotech Diagnostics Lab; owns uncashable stocks for Atherotech Diagnostics Labs; and receives royalties from the University of Alabama at Birmingham. Dr. Kwiterovich is a consultant for Merck & Co.; and has received research grants from Amarin , GlaxoSmithKline , and Pfizer . Dr. Jones is a member of the scientific advisory board and has received research grant support from Atherotech Diagnostics; and has unexercised stock options for and is on the scientific advisory board of LabRoots/BioConference Live. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
PY - 2013/11/19
Y1 - 2013/11/19
N2 - Objectives This study sought to examine patient-level discordance between population percentiles of non-high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C). Background Non-HDL-C is an alternative to LDL-C for risk stratification and lipid-lowering therapy. The justification for the present guideline-based non-HDL-C cutpoints of 30 mg/dl higher than the LDL-C cutpoints remains largely untested. Methods We assigned population percentiles to non-HDL-C and Friedewald-estimated LDL-C values of 1,310,440 U.S. adults with triglyceride levels <400 mg/dl who underwent lipid testing by vertical spin density gradient ultracentrifugation (Atherotech, Birmingham, Alabama) from 2009 to 2011. Results LDL-C cutpoints of 70, 100, 130, 160, and 190 mg/dl were in the same population percentiles as non-HDL-C values of 93, 125, 157, 190, and 223 mg/dl, respectively. Non-HDL-C values reclassified a significant proportion of patients within or to a higher treatment category compared with Friedewald LDL-C values, especially at LDL-C levels in the treatment range of high-risk patients and at triglyceride levels ≥150 mg/dl. Of patients with LDL-C levels <70 mg/dl, 15% had a non-HDL-C level ≥100 mg/dl (guideline-based cutpoint) and 25% had a non-HDL-C level ≥93 mg/dl (percentile-based cutpoint); if triglyceride levels were 150 to 199 mg/dl concurrently, these values were 22% and 50%, respectively. Conclusions There is significant patient-level discordance between non-HDL-C and LDL-C percentiles at lower LDL-C and higher triglyceride levels, which has implications for the treatment of high-risk patients. Current non-HDL-C cutpoints for high-risk patients may need to be lowered to match percentiles of LDL-C cutpoints. Relatively small absolute reductions in non-HDL-C cutpoints result in substantial reclassification of patients to higher treatment categories with potential implications for risk assessment and treatment. (The Very Large Database of Lipids [VLDL-2]; NCT01698489).
AB - Objectives This study sought to examine patient-level discordance between population percentiles of non-high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C). Background Non-HDL-C is an alternative to LDL-C for risk stratification and lipid-lowering therapy. The justification for the present guideline-based non-HDL-C cutpoints of 30 mg/dl higher than the LDL-C cutpoints remains largely untested. Methods We assigned population percentiles to non-HDL-C and Friedewald-estimated LDL-C values of 1,310,440 U.S. adults with triglyceride levels <400 mg/dl who underwent lipid testing by vertical spin density gradient ultracentrifugation (Atherotech, Birmingham, Alabama) from 2009 to 2011. Results LDL-C cutpoints of 70, 100, 130, 160, and 190 mg/dl were in the same population percentiles as non-HDL-C values of 93, 125, 157, 190, and 223 mg/dl, respectively. Non-HDL-C values reclassified a significant proportion of patients within or to a higher treatment category compared with Friedewald LDL-C values, especially at LDL-C levels in the treatment range of high-risk patients and at triglyceride levels ≥150 mg/dl. Of patients with LDL-C levels <70 mg/dl, 15% had a non-HDL-C level ≥100 mg/dl (guideline-based cutpoint) and 25% had a non-HDL-C level ≥93 mg/dl (percentile-based cutpoint); if triglyceride levels were 150 to 199 mg/dl concurrently, these values were 22% and 50%, respectively. Conclusions There is significant patient-level discordance between non-HDL-C and LDL-C percentiles at lower LDL-C and higher triglyceride levels, which has implications for the treatment of high-risk patients. Current non-HDL-C cutpoints for high-risk patients may need to be lowered to match percentiles of LDL-C cutpoints. Relatively small absolute reductions in non-HDL-C cutpoints result in substantial reclassification of patients to higher treatment categories with potential implications for risk assessment and treatment. (The Very Large Database of Lipids [VLDL-2]; NCT01698489).
KW - LDL cholesterol
KW - discordance
KW - lipids
KW - non-HDL cholesterol
KW - percentiles
KW - secondary prevention
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U2 - 10.1016/j.jacc.2013.07.045
DO - 10.1016/j.jacc.2013.07.045
M3 - Article
C2 - 23973689
AN - SCOPUS:84888211663
SN - 0735-1097
VL - 62
SP - 1960
EP - 1965
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 21
ER -