Advances in Therapy

, Volume 26, Issue 7, pp 711–718 | Cite as

Dyslipidemia therapy update: the importance of full lipid profile assessment

  • I. B. A. Menown
  • G. Murtagh
  • V. Maher
  • M. T. Cooney
  • I. M. Graham
  • G. Tomkin
Review

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.

Keywords

cardiovascular risk cholesterol dyslipidemia high-density lipoprotein cholesterol triglycerides 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    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.PubMedCrossRefGoogle Scholar
  2. 2.
    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.Google Scholar
  3. 3.
    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.CrossRefGoogle Scholar
  4. 4.
    Menown IBA. HDL cholesterol — a new target for cardiovascular intervention. Cardiol News. 2006;9:11–13.Google Scholar
  5. 5.
    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.PubMedCrossRefGoogle Scholar
  6. 6.
    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.Google Scholar
  7. 7.
    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.Google Scholar
  8. 8.
    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.PubMedCrossRefGoogle Scholar
  9. 9.
    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.PubMedCrossRefGoogle Scholar
  10. 10.
    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.PubMedCrossRefGoogle Scholar
  11. 11.
    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.Google Scholar
  12. 12.
    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.PubMedCrossRefGoogle Scholar
  13. 13.
    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.Google Scholar
  14. 14.
    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.PubMedCrossRefGoogle Scholar
  15. 15.
    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.PubMedGoogle Scholar
  16. 16.
    Rhoads GG, Feinleib M. Honolulu Heart Study. Arteriosclerosis. 1983;3:316–322.PubMedGoogle Scholar
  17. 17.
    Assmann G, Schulte H. Prospective Cardiovascular Münster Study. Am J Cardiol. 1992;70:733–737.PubMedCrossRefGoogle Scholar
  18. 18.
    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.PubMedCrossRefGoogle Scholar
  19. 19.
    Balkau B, Deanfield JD, Despres J-P, et al. International day for the evaluation of abdominal obesity (IDEA). Circulation. 2007;116:1941–1951.CrossRefGoogle Scholar
  20. 20.
    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.PubMedCrossRefGoogle Scholar
  21. 21.
    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.PubMedCrossRefGoogle Scholar
  22. 22.
    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.PubMedCrossRefGoogle Scholar
  23. 23.
    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.CrossRefGoogle Scholar
  24. 24.
    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.Google Scholar
  25. 25.
    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.PubMedCrossRefGoogle Scholar
  26. 26.
    Taskinen MR. Diabetic dyslipidaemia: from basic research to clinical practice. Diabetologia. 2003;46:733–749.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Healthcare Communications 2009

Authors and Affiliations

  • I. B. A. Menown
    • 1
  • G. Murtagh
    • 2
  • V. Maher
    • 2
  • M. T. Cooney
    • 2
  • I. M. Graham
    • 2
  • G. Tomkin
    • 3
  1. 1.Craigavon Cardiac Centre, CraigavonNorthern IrelandUK
  2. 2.Adelaide, Meath and National Children’s Hospital (AMNCH), TallaghtDublinIreland
  3. 3.Diabetes Institute of Ireland, Beacon Clinic, SandyfordDublinIreland

Personalised recommendations