The importance of LDL-C lowering in atherosclerotic cardiovascular disease prevention: Lower for longer is better

American Journal of Preventive Cardiology, Год журнала: 2024, Номер 18, С. 100649 - 100649

Опубликована: Март 18, 2024

Cumulative exposure to low-density lipoprotein cholesterol (LDL-C) is a key driver of atherosclerotic cardiovascular disease (ASCVD) risk. An armamentarium therapies achieve robust and sustained reduction in LDL-C can reduce ASCVD The gold standard for assessment ultracentrifugation but routine clinical practice usually calculated the most accurate calculation obtained through Martin/Hopkins equation. For primary prevention, consideration estimated risk frames decision making regarding use statins other therapies, tools such as enhancing factors coronary artery calcium enable tailoring making. In patients with diabetes, lipid lowering therapy recommended an opportunity tailor based on factors. Patients hypercholesterolemia familial (FH) baseline greater than or equal 190 mg/dL are at elevated risk, high-intensity statin often combined non-statin prevent ASCVD. Secondary prevention ASCVD, including prior myocardial infarction stroke, requires intensive lifestyle modification approaches. There no established level below which benefit ceases safety concerns arise. When further required beyond modifications therapy, additional medications include oral ezetimibe bempedoic acid, injectables PCSK9 monoclonal antibodies siRNA therapy. A novel agent that acts independently hepatic LDL receptors evinacumab, approved homozygous FH. Other emerging agents targeted Lp(a) CETP. Given dyslipidemia, this manuscript reviews importance early, intensive, LDL-C-lowering secondary

Язык: Английский

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Testing practices and clinical management of lipoprotein(a) levels: A 5-year retrospective analysis from the Johns Hopkins Hospital

American Journal of Preventive Cardiology, Год журнала: 2024, Номер 19, С. 100686 - 100686

Опубликована: Июнь 19, 2024

Elevated lipoprotein(a) [Lp(a)] is an independent, genetically determined risk factor for atherosclerotic cardiovascular disease (ASCVD). We evaluated the frequency of testing elevated Lp(a) and subsequent management at Johns Hopkins Hospital, a large academic medical center, over 5-year period. The Hospital (JHH) electronic record was queried to identify patients with encounter between 2017-2021, either established ASCVD or increased risk, defined as being on any lipid lowering medication having LDL-C ≥190 mg/dL. levels (≥75 nmol/L) were identified each year. Among 111,350 unique adult patients, 2,785 (2.5%) had least one test. Patients testing, compared those without younger (mean age 56 years vs. 66), more often female (49% 44%), Black (24.7% 24.6%) "other" race/ethnicity (12% vs 10%), higher (median 118 91 mg/dL; p<0.001). number from 167 (0.57%) in 2017 1155 (5.67%) 2021. 43.4% (moderate [75-125]: 10.3%, high [125-600]: 32.2%, severe [>600]: 0.9%). 920 levels, 200 (22%) referral cardiology specialist, 180 (20%) lipid-lowering prescribed 18 months. Based single-center experience, incident among increased-risk low but significantly 5-years, likely largely due Lipid Clinic referrals reflex greater awareness about this factor. Future work should target appropriate population based strategies clinical decision-making regarding once elevation diagnosed.

Язык: Английский

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Fatigued with Friedewald: why isn't everyone onboard yet with the new LDL-C equations?

Frontiers in Cardiovascular Medicine, Год журнала: 2025, Номер 12

Опубликована: Фев. 27, 2025

Many laboratories utilize direct LDL-C assays as part of a reflex protocol at TG >400 mg/dL. Despite the cost associated with testing in place freely available calculations, some still prefer assay lipid panel. This approach is followed regardless patient's or levels. However, Miller et al. have shown biases assays, often leading to overestimating dyslipidemia patients (7). Importantly, their analytical performance current context potent lipid-lowering therapies and stringent target levels remained insufficiently evaluated. It notable that are also susceptible discrepancies due different methodologies inherent Although newer equations been independently verified calculate up 800 mg/dL reasonable accuracy compared measurements populations (13)(14)(15), >500 mg/dL, clinical priority, these cases, should be first reduce elevated level prevent acute pancreatitis. Given this need relatively better new calculations-based estimations even higher (Sampson-NIH, mg/dL) lower (Martin/Hopkins equation, <70 mg/dL), it apparent fewer will only require reflexive measurements.However, must noted no calculation method perfect, measurement may necessary particularly when precise quantification very low critical for decision-making. Notably, case rare disorders type III hyperlipidemia, FW equation performs poorly inaccurate VLDL-C estimation. Martin/Hopkins uses an adjustable factor TG:VLDL-C ratio, which provide more accurate estimates atypical profiles. Nevertheless, they limitations accurately estimating hyperlipidemia condition's unique profile accumulation remnant lipoproteins. Also, post-prandial conditions, unlike limited fasting samples, perform equally well both non-fasting samples. Thus, while offer improvements over can largely curtail measurements, not eliminate entirely, especially high (>800 extremely (below 40 disorders. important know discordant, cardiovascular risk and/or Table 1 summarizes estimation methods comparison.Given ADLM other associations acknowledged strength equations, address why we stuck old era using equation? Recent informal surveys indicating slight increase adoption uptake remains lukewarm. raises questions: What barriers implementing equations? Why does reluctance move on from persist? Is driven by convenience perceived complications?We believe primary reason lies sticking routine practices strong change, has entrenched use 5 decades now. indeed fueled absence universal guidelines. Without clear consensus about how benefit patients, practitioners facilities adopt "if it's broken, don't fix it" continue established practices.One factors hindering implementation particularly, MH prevalent misconception copyrighted would licensing fee its commercial use. recently clarified royalty-free, addressing concern. Additionally, confusion linger term "free" "royalty-free", could interpreted free ongoing royalties but significant one-time specific terms. Recently, Johns Hopkins University abandoned patent application facilitate without intellectual property restrictions (16). decision means formula allowed broader access used modified any barriers. previously misconstrued concern regarding "no royalty-free" notion longer issue transition equation. Furthermore, despite complexity made readily accessible formats seamlessly integrated into LIS middleware systems like Data Innovations. Laboratories encouraged contact [email protected] [email protected] assistance process Indeed, gone step further willing share line-by-line sample code labs/health intending implement allows faster, convenient implementation, each visible modifiable adaptability across platforms lab protocols. Besides, foster collaboration troubleshooting through peer-reviewed snippets. equation's ease exemplified increasing While recent changes reflect growing recognition value there now momentum towards next-gen far complete. served decades, well-known negative bias contributes undertreatment major therapy (22).Whatever use, convenience, familiarity, becoming increasingly untenable persist given crucial role plays management disease, worldwide cause death morbidity. our view long past break conservative mindset one specifically Sampson-NIH.

Язык: Английский

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Cardiovascular disease lipids and lipoproteins biomarker standardization

Critical Reviews in Clinical Laboratory Sciences, Год журнала: 2025, Номер unknown, С. 1 - 22

Опубликована: Март 1, 2025

Cardiovascular disease (CVD) is the leading cause of mortality in United States and globally. This review describes changes CVD lipid lipoprotein biomarker measurements that occurred line with evolution clinical practice guidelines for risk assessment treatment. It also discusses level comparability these practice. Comparable reliable are achieved through assay standardization, which not only depends on correct test calibration but factors such as analytical sensitivity, selectivity, susceptibility to can affect measurement process, stability system over time. The current status standardization traditional newer biomarkers discussed, approaches setting achieving goals low-density cholesterol (LDL-C), high-density (HDL-C), total (TC), triglycerides (TG), lipoprotein(a) (Lp(a)), apolipoproteins (apo) A-I B, non-HDL-C. Appropriate levels blood lipids maintained by Centers Disease Control Prevention's (CDC) Biomarkers Standardization Program (CDC BSP) using performance recommended National Cholesterol Education Program. agreement be dependent characteristics analytes differences principles between reference procedures assays. technical limitations observed apolipoproteins. Additionally, apoB Lp(a) may more accurately capture residual risk, respectively, than lipids, thus prompting recommend apolipoprotein measurements. further CDC's approach apoA-I B past 11 years. systems previously a single laboratory, no longer exist, requiring creation new systems, currently underway. situation emphasizes importance collaborative network laboratories, Reference Methods Laboratory Network (CRMLN), ensure sustainability. CDC supporting International Federation Clinical Chemistry Medicine's (IFCC) work establish lipoproteins. Ensuring reliability remains critical effective implementation improving patient care. Utilizing experience gained three decades, BSP will continue improve emerging together stakeholders.

Язык: Английский

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Remnant cholesterol, lipid ratios, and the severity of coronary artery lesions: a retrospective cohort study in patients with coronary heart disease

Frontiers in Cardiovascular Medicine, Год журнала: 2025, Номер 12

Опубликована: Март 10, 2025

Background Emerging genetic and observational evidence indicates that remnant cholesterol (RC) is a significant residual risk factor for cardiovascular diseases. However, there relative paucity of exploring the correlation among RC, lipid ratios, atherosclerotic lesion severity. This study aimed to investigate predictive value RC ratios alone or in combination severity coronary artery stenosis patients with heart disease (CHD). Methods The Gensini score was used assess lesions. CHD were categorized into mild moderate-to-severe groups. Logistic regression evaluate high associated ratios. Our also examined relationship between inconsistencies non-high-density lipoprotein (non-HDL-C) levels stenosis. Receiver operating characteristic (ROC) curves power moderate severe Results Multivariate models suggested strong predictor [odds ratio (OR): 5.44, P &lt; 0.001]. When grouped by curve-fitting inflection points, group inconsistent RC/low non-HDL-C, rather than low RC/high non-HDL-C group, an increased compared consistent (OR: 2.72, 0.001). ROC showed predicted area under curve (AUC) 0.715 severity, improving efficacy combined predictors comprising (AUC: 0.723 vs. 0.703, 0.05). Conclusions various [triglyceride/HDL-C, total cholesterol/HDL-C, low-density apoloprotein (apo)B/apoA] correlated degree CHD, suggesting has potential as biomarker reflecting independent traditional factors non-HDL-C. could enhance based on model had better

Язык: Английский

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Calculation formulas for low density lipoprotein cholesterol in cardiological practice: the more, the better?

Almanac of Clinical Medicine, Год журнала: 2025, Номер 53(1), С. 43 - 52

Опубликована: Март 18, 2025

Monitoring of low density lipoprotein cholesterol (LDL-C) levels is a key element anti-atherogenic therapy in patients with atherosclerotic cardiovascular diseases, especially those at high and very risk. The target LDL-C ( 1.8 mmol/L for risk 1.4 risk) are important indicators quality medical care. Traditionally, the Friedewald formula has been used to estimate LDL-C, but its accuracy limited when triglyceride (TG) exceed 4.5 mmol/L. This article reviews current approaches optimization calculation formulas, their applicability clinical practice, regional variations. formula, proposed 1972, long primary method estimation. However, limitations, particularly TG levels, have led development alternative such as Martin Sampson formula. method, based on analysis over 1.35 million lipid profiles, suggests use correction factors depending levels. which accounts complex metabolic processes, demonstrates accuracy, There variations associated climatic, cultural, genetic factors. For example, South Korea, tailored local population proposed, showing higher compared In Russian Federation, 750,000 profiles developed, demonstrating across wide range (0.1–30 mmol/L). These studies highlight need adapt methods populations. choice depends study objectives characteristics disease. American Heart Association (AHA) recommends while National Institute Health (NIH) favors Russia, still used, although questioned. multicenter lipid-lowering drugs, newer formulas preferred, NIH shown accurate determination assess monitor treatment efficacy drives new methods. despite widespread use, less than modern methods, Optimization account seems an step toward improvement diagnosis diseases.

Язык: Английский

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Beneficial Changes in Total Cholesterol, LDL-C, Biomarkers of Intestinal Inflammation, and Vitamin E status in Adults with Metabolic Syndrome Consuming Almonds as Snack Foods: A Randomized Controlled Clinical Trial

Nutrition Research, Год журнала: 2025, Номер 139, С. 50 - 65

Опубликована: Апрель 25, 2025

Язык: Английский

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The unique association between serum 25-hydroxyvitamin D concentrations and blood lipid profiles in agriculture, forestry, and fishing occupations: Insights from NHANES 2001–2014

PLoS ONE, Год журнала: 2024, Номер 19(2), С. e0297873 - e0297873

Опубликована: Фев. 27, 2024

Background The relationship of serum 25(OH)D levels and hyperlipidemia has not been explored in the Agriculture, Forestry, Fishing (AFF) occupation. We aimed to explore impact on lipid profiles AFF workers, traffic drivers, miners. Methods Data from 3937 adults aged 18–65 years old with completed information were obtained National Health Examination Survey 2001 2014. Multivariate linear regression models used examine associations between concentrations triglycerides (TG), total cholesterol (TC), low-density lipoprotein (LDL-C), high-density (HDL-C) HDL-C/LDL-C ratio. Subgroup analyses for workers considered age, sex, BMI, work activity, months worked, alcohol consumption. Non-linear relationships using curve fitting. Results Serum differed groups (AFF: 60.0 ± 21.3 nmol/L, drivers: 56.6 22.2 miners: 62.8 22.3 nmol/L). analysis group showed that participants ≥50 females, BMI <30 kg/m 2 demonstrated improved HDL-C correlating higher 25(OH)D. had a reversed U-shaped TG TC, HDL-C, inflection points at 49.5 nmol/L 32.6 HDL-C. Conclusions are associated profiles, varies among occupational groups. facing unique challenges, may benefit maintaining adequate mitigate adverse reduce cardiovascular risk.

Язык: Английский

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Evaluation of 13 Formulae for Calculated LDL-C Using Direct Homogenous Assay in a South Indian Population

The Journal of Applied Laboratory Medicine, Год журнала: 2024, Номер 9(5), С. 963 - 977

Опубликована: Май 29, 2024

LDL cholesterol (LDL-C) is regarded as a significant therapeutic target and known risk factor for atherosclerosis. It can be calculated using the results of other lipid tests or tested directly. Despite its shortcomings, Friedewald formula most frequently utilized since it simple practical. Until now, several formulae have been proposed calculating LDL-C; however, their accuracy has not evaluated across different populations. We sought to evaluate validity LDL-C by comparing findings with values acquired direct homogeneous technique, utilizing 13 distinct from literature.

Язык: Английский

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Choosing the right equation for calculating indirect LDL-Cholesterol (LDL-C) in adult Pakistani population: Evaluation of seven equations using big data analytics

Practical Laboratory Medicine, Год журнала: 2024, Номер 41, С. e00418 - e00418

Опубликована: Июль 10, 2024

Cardiovascular diseases (CVDs) are a leading cause of mortality worldwide. Low density lipoprotein cholesterol (LDL-C) contributes to the atherogenic process. However, direct LDL-C (d-LDL) has rarely been estimated by gold standard method because it is cumbersome and expensive. We aim evaluate calculated low (LDL-c) various equations with reference directly measured in Pakistani adult population as cost-effective alternative.

Язык: Английский

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