Om P Ganda1. 1. Section of Adult Medicine, Joslin Diabetes Center, Beth-Israel Medical Center, Department of Medicine, Harvard Medical School, Boston, Massachusetts 02215, USA. om.ganda@joslin.harvard.edu
Abstract
OBJECTIVE: To summarize the data that support the measurement of apolipoprotein B as an accurate reflection of low-density lipoprotein (LDL) particle number and an easily adapted parameter in clinical practice. METHODS: Study findings are reviewed and a flow chart is provided to guide lipid assessment in patients with dyslipidemia. RESULTS: Current treatment guidelines for lipid management emphasize LDL cholesterol as the primary treatment target in patients at high risk of cardiovascular events. However, LDL cholesterol is a poor surrogate for LDL particle number, particularly in patients with altered LDL composition, such as those with insulin resistance, metabolic syndrome, and type 2 diabetes. Direct measurement of LDL particle number or size is not practical because of methodology and cost considerations. A suggested alternative target in patients with hypertriglyceridemia is non-high-density lipoprotein (HDL) cholesterol. Abundant evidence suggests that even non-HDL cholesterol is an inadequate approximation of the LDL particle number in such patients. The flow chart emphasizes the need to continue achieving the well-established LDL-cholesterol goal, while also considering apolipoprotein B measurement in those with hypertriglyceridemia, rather than relying on the less accurate surrogate of non-HDL cholesterol, when targeting therapy in such patients. CONCLUSION: Presented evidence supports the measurement of apolipoprotein B as a more accurate reflection of LDL particle number than non-HDL cholesterol, and it is an easily adapted parameter in clinical practice.
OBJECTIVE: To summarize the data that support the measurement of apolipoprotein B as an accurate reflection of low-density lipoprotein (LDL) particle number and an easily adapted parameter in clinical practice. METHODS: Study findings are reviewed and a flow chart is provided to guide lipid assessment in patients with dyslipidemia. RESULTS: Current treatment guidelines for lipid management emphasize LDL cholesterol as the primary treatment target in patients at high risk of cardiovascular events. However, LDL cholesterol is a poor surrogate for LDL particle number, particularly in patients with altered LDL composition, such as those with insulin resistance, metabolic syndrome, and type 2 diabetes. Direct measurement of LDL particle number or size is not practical because of methodology and cost considerations. A suggested alternative target in patients with hypertriglyceridemia is non-high-density lipoprotein (HDL) cholesterol. Abundant evidence suggests that even non-HDL cholesterol is an inadequate approximation of the LDL particle number in such patients. The flow chart emphasizes the need to continue achieving the well-established LDL-cholesterol goal, while also considering apolipoprotein B measurement in those with hypertriglyceridemia, rather than relying on the less accurate surrogate of non-HDL cholesterol, when targeting therapy in such patients. CONCLUSION: Presented evidence supports the measurement of apolipoprotein B as a more accurate reflection of LDL particle number than non-HDL cholesterol, and it is an easily adapted parameter in clinical practice.
Authors: Adam Wright; Dean F Sittig; Joan S Ash; David W Bates; Joshua Feblowitz; Greg Fraser; Saverio M Maviglia; Carmit McMullen; W Paul Nichol; Justine E Pang; Jack Starmer; Blackford Middleton Journal: J Am Med Inform Assoc Date: 2011-01-20 Impact factor: 4.497