Mohamed B Elshazly1, Renato Quispe2, Erin D Michos2, Allan D Sniderman2, Peter P Toth2, Maciej Banach2, Krishnaji R Kulkarni2, Josef Coresh2, Roger S Blumenthal2, Steven R Jones2, Seth S Martin2. 1. 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.). elshazm@ccf.org mes2015@qatar-med.cornell.edu. 2. 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.).
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.
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.
Authors: Terry A Jacobson; Matthew K Ito; Kevin C Maki; Carl E Orringer; Harold E Bays; Peter H Jones; James M McKenney; Scott M Grundy; Edward A Gill; Robert A Wild; Don P Wilson; W Virgil Brown Journal: J Clin Lipidol Date: 2014-07-15 Impact factor: 4.766
Authors: James D Otvos; Samia Mora; Irina Shalaurova; Philip Greenland; Rachel H Mackey; David C Goff Journal: J Clin Lipidol Date: 2011 Mar-Apr Impact factor: 4.766
Authors: Emil M Degoma; Mat D Davis; Richard L Dunbar; Emile R Mohler; Philip Greenland; Benjamin French Journal: Atherosclerosis Date: 2013-03-26 Impact factor: 5.162
Authors: Todd J Anderson; Jean Grégoire; Robert A Hegele; Patrick Couture; G B John Mancini; Ruth McPherson; Gordon A Francis; Paul Poirier; David C Lau; Steven Grover; Jacques Genest; André C Carpentier; Robert Dufour; Milan Gupta; Richard Ward; Lawrence A Leiter; Eva Lonn; Dominic S Ng; Glen J Pearson; Gillian M Yates; James A Stone; Ehud Ur Journal: Can J Cardiol Date: 2013-02 Impact factor: 5.223
Authors: William C Cromwell; James D Otvos; Michelle J Keyes; Michael J Pencina; Lisa Sullivan; Ramachandran S Vasan; Peter W F Wilson; Ralph B D'Agostino Journal: J Clin Lipidol Date: 2007-12 Impact factor: 4.766
Authors: Renato Quispe; Mohamed B Elshazly; Di Zhao; Peter P Toth; Rishi Puri; Salim S Virani; Roger S Blumenthal; Seth S Martin; Steven R Jones; Erin D Michos Journal: Eur J Prev Cardiol Date: 2019-07-10 Impact factor: 7.804
Authors: Maciej Banach; Wilbert S Aronow; Maria-Corina Serban; Jacek Rysz; Luminita Voroneanu; Adrian Covic Journal: Lipids Health Dis Date: 2015-12-30 Impact factor: 3.876
Authors: Domingo Orozco-Beltran; Vicente F Gil-Guillen; Josep Redon; Jose M Martin-Moreno; Vicente Pallares-Carratala; Jorge Navarro-Perez; Francisco Valls-Roca; Carlos Sanchis-Domenech; Antonio Fernandez-Gimenez; Ana Perez-Navarro; Vicente Bertomeu-Martinez; Vicente Bertomeu-Gonzalez; Alberto Cordero; Manuel Pascual de la Torre; Jose L Trillo; Concepcion Carratala-Munuera; Salvador Pita-Fernandez; Ruth Uso; Ramon Durazo-Arvizu; Richard Cooper; Gines Sanz; Jose M Castellano; Juan F Ascaso; Rafael Carmena; Maria Tellez-Plaza Journal: PLoS One Date: 2017-10-18 Impact factor: 3.240
Authors: Claire Welsh; Carlos A Celis-Morales; Rosemary Brown; Daniel F Mackay; James Lewsey; Patrick B Mark; Stuart R Gray; Lyn D Ferguson; Jana J Anderson; Donald M Lyall; John G Cleland; Pardeep S Jhund; Jason M R Gill; Jill P Pell; Naveed Sattar; Paul Welsh Journal: Circulation Date: 2019-06-20 Impact factor: 29.690