Abstract
Lipid guidelines typically focus on total cholesterol ± low-density lipoprotein cholesterol levels with less emphasis on high-density lipoprotein cholesterol (HDL-C) or triglyceride assessment, thus potentially underestimating cardiovascular (CV) risk and the need for lifestyle or treatment optimization. In this article, we highlight how reliance on isolated total cholesterol assessment may miss prognostically relevant lipid abnormalities; we describe from the European Systematic COronary Risk Evaluation (SCORE) data set how incorporation of HDL-C may improve estimation of CV risk; and, finally, we critically evaluate the evidence base surrounding triglycerides and CV risk.
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Graham I, Atar D, Borch-Johnsen K, et al. European guidelines on cardiovascular disease prevention in clinical practice. Eur J Cardiovasc Prev Rehabil. 2007;14(suppl. 2):S1–S113.
Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002;106:3143–3421.
British Cardiac Society, British Hypertension Society, Diabetes UK, HEART UK, Primary Care Cardiovascular Society, Stroke Association. JBS 2: Joint British Societies’ guidelines on prevention of cardiovascular disease in clinical practice. Heart. 2005; 91(suppl. 5):1–52.
Menown IBA. HDL cholesterol — a new target for cardiovascular intervention. Cardiol News. 2006;9:11–13.
Ginsburg GS, Safran C, Pasternak RC. Frequency of low serum high-density lipoprotein cholesterol levels in hospitalized patients with “desirable” total cholesterol levels. Am J Cardiol. 1991;68:187–192.
Abbott RD, Wilson PW, Kannel WB, Castelli WP. High density lipoprotein cholesterol, total cholesterol screening, and myocardial infarction. The Framingham study. Arteriosclerosis. 1988;8:207–211.
Murtagh G, Kiernan TJ, Tekle S, Boran G, Maher V. Isolated cholesterol measurements hide significant lipid abnormalities. Paper presented at: Irish Atherosclerosis Society; October 11, 2008; Galway, Ireland.
Assmann G, Schulte H, von Eckardstein A, Huang Y. High-density lipoprotein cholesterol as a predictor of coronary heart disease risk. Atherosclerosis. 1996;124:S11–S20.
Conroy RM, Pyörälä K, Fitzgerald AP, et al. Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J. 2003;24:987–1003.
Ingelsson E, Schaefer EJ, Contois JH, et al. Clinical utility of different lipid measures for prediction of coronary heart disease in men and women. JAMA. 2007;298:776–785.
Cooney MT, Dudina A, Graham I. SCORE HDL — incorporation of HDL into risk estimation. Paper presented at: Irish Atherosclerosis Society; October 11, 2008; Galway, Ireland.
Pencina MJ, D’Agostino RB Sr, D’Agostino RB Jr, Vasan RS. Evaluating the added predictive ability of a new marker: from area under the ROC curve to reclassification and beyond. Stat Med. 2008;27: 157–172.
Durrington PN. Lipid and lipoprotein disorders. In: Weatherall DJ, Ledingham JGG, Warrell DA, eds. Oxford Textbook of Medicine. Oxford: Oxford University Press; 1996:1399–1415.
Maher VMG, Gallagher JJ, Myant NB. The binding of very-low-density lipoprotein remnants to the low-density lipoprotein receptor in patients with familial defective apolipoprotein B-100. Atherosclerosis. 1993;102:51–61.
Kokolis S, Marmur JD, Clark LT, et al. Effects of alcoholism on coronary artery disease and left ventricular dysfunction in male veterans. J Invasive Cardiol. 2006;18:304–307.
Rhoads GG, Feinleib M. Honolulu Heart Study. Arteriosclerosis. 1983;3:316–322.
Assmann G, Schulte H. Prospective Cardiovascular Münster Study. Am J Cardiol. 1992;70:733–737.
Manninen V, Elo MO, Frick MH, et al. Lipid alterations and decline in the incidence of coronary heart disease in the Helsinki Heart Study. JAMA. 1988;260:641–651.
Balkau B, Deanfield JD, Despres J-P, et al. International day for the evaluation of abdominal obesity (IDEA). Circulation. 2007;116:1941–1951.
Bos G, Dekker JM, Nijpels G, et al. A combination of high concentrations of serum triglyceride and non-high-density-lipoprotein-cholesterol is a risk factor for cardiovascular disease in subjects with abnormal glucose metabolism — the Hoorn study. Diabetologia. 2003;46:910–916.
Bansal S, Buring JE, Rifai N, et al. Fasting compared with nonfasting triglycerides and risk of cardiovascular events in women. JAMA. 2007;298:309–316.
Nordestgaard BG, Benn M, Schnohr P, Tybjaerg-Hansen A. Nonfasting triglycerides and risk of myocardial infarction, ischemic heart disease, and death in men and women. JAMA. 2007;298:299–308.
Diabetes Atherosclerosis Intervention Study Investigators. Effect of fenofibrate on progression of coronary-artery disease in type 2 diabetes: the Diabetes Atherosclerosis Intervention Study, a randomised study. Lancet. 2001;357:905–909.
Muragasu G, Phillips C, Owens D, Collins P, Johnson A, Tomkin GH. Effect of improvement in glycaemic control on apo B48 and post-prandial lipoproteins in non-insulin-dependent diabetes. Diabet Med. 1998;15:S3.
Proctor SD, Mamo JC. Retention of fluorescentlabelled chylomicron remnants within the intima of the arterial wall — evidence that plaque cholesterol may be derived from post-prandial lipoproteins. Eur J Clin Invest. 1998;28:497–503.
Taskinen MR. Diabetic dyslipidaemia: from basic research to clinical practice. Diabetologia. 2003;46:733–749.
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Menown, I.B.A., Murtagh, G., Maher, V. et al. Dyslipidemia therapy update: the importance of full lipid profile assessment. Adv Therapy 26, 711–718 (2009). https://doi.org/10.1007/s12325-009-0052-3
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DOI: https://doi.org/10.1007/s12325-009-0052-3