期刊
JOURNAL OF THE AMERICAN HEART ASSOCIATION
卷 9, 期 23, 页码 -出版社
WILEY
DOI: 10.1161/JAHA.119.016318
关键词
cholesterol; guidelines; lipoprotein(a); low‐ density lipoprotein
资金
- Fondation Leducq
- American Heart Association [17POST33660462]
- Dr.-Johannes-and-Hertha-Tuba-Foundation
Background Conventional low-density lipoprotein cholesterol (LDL-C) assays measure cholesterol content in both low-density lipoprotein and lipoprotein(a) particles. To clarify the consequences of this methodological limitation for clinical care, our study aimed to compare associations of LDL-C and corrected LDL-C with risk of cardiovascular disease and to assess the impact of this correction on the classification of patients into guideline-recommended LDL-C categories. Methods and Results Lipoprotein(a) cholesterol content was estimated as 30% of lipoprotein(a) mass and subtracted from LDL-C to obtain corrected LDL-C values (LDL-C-corr30). Hazard ratios for cardiovascular disease (defined as coronary heart disease, stroke, or coronary revascularization) were quantified by individual-patient-data meta-analysis of 5 statin landmark trials from the Lipoprotein(a) Studies Collaboration (18 043 patients; 5390 events; 4.7 years median follow-up). When comparing top versus bottom quartiles, the multivariable-adjusted hazard ratio for cardiovascular disease was significant for LDL-C (1.17; 95% CI, 1.05-1.31; P=0.005) but not for LDL-C-corr30 (1.07; 95% CI, 0.93-1.22; P=0.362). In a routine laboratory database involving 531 144 patients, reclassification of patients across guideline-recommended LDL-C categories when using LDL-C-corr30 was assessed. In LDL-C categories of 70 to <100, 100 to <130, 130 to <190, and >= 190 mg/dL, significant proportions (95% CI) of participants were reassigned to lower LDL-C categories when LDL-C-corr30 was used: 30.2% (30.0%-30.4%), 35.1% (34.9%-35.4%), 32.9% (32.6%-33.1%), and 41.1% (40.0%-42.2%), respectively. Conclusions LDL-C was associated with incident cardiovascular disease only when lipoprotein(a) cholesterol content was included in its measurement. Refinement in techniques to accurately measure LDL-C, particularly in patients with elevated lipoprotein(a) levels, is warranted to assign risk to the responsible lipoproteins.
作者
我是这篇论文的作者
点击您的名字以认领此论文并将其添加到您的个人资料中。
推荐
暂无数据