Division of Cardiovascular Medicine, University of Michigan, 24 Frank Lloyd Wright Drive, PO Box 322, Ann Arbor, MI 48106, USA.
Division of Cardiovascular Medicine, University of Michigan, 24 Frank Lloyd Wright Drive, PO Box 322, Ann Arbor, MI 48106, USA.
J Clin Lipidol. 2011 May-Jun;5(3):159-165. doi: 10.1016/j.jacl.2011.02.004. Epub 2011 Feb 12.
Apolipoprotein-B/A-1 (apoB/A-R) and total/high-density lipoprotein-cholesterol ratios (TC/HDL-R) outperform non-high-density lipoprotein-cholesterol (non-HDL-C) suggested by Adult Treatment Panel (ATP) III guidelines for predicting cardiovascular (CV) outcomes.
To evaluate the potential effects that implementing our proposed apoB/A-R and TC/HDL-R treatment algorithms would have on clinical management.
We performed a chart review of all patients referred to the University of Michigan Lipid Clinic from January 2004 to June 2010. ATP III guidelines, including Framingham Risk Scores, were used to determine whether patients met non-HDL-C goals upon referral. Next, we evaluated whether subsequent management would differ if algorithms based upon potential apoB/A-R or TC/HDL-R targets derived from the literature were followed.
Among patients (n = 692), mean non-HDL-C, apoB/A-R, and TC/HDL-R were 192.2 ± 85.8 mg/dL, 0.92 ± 0.64, and 6.7 ± 8.0, respectively. Although moderately well correlated with apoB (r = 0.56, P < .01), non-HDL-C was less related to apoB/A-R (r = 0.20, P < .01) and TC/HDL-R (r = 0.39, P < .01). Most low-risk patients (<2 risk factors; n = 207) at non-HDL-C goal (<190 mg/dL) also met apoB/A-R <0.9 (79%) and TC/HDL-R <6.0 (92%) targets. However, a minority of high-risk patients (Framingham Risk Score >20%, cardiovascular disease or risk equivalent; n = 307) meeting non-HDL-C goal (<130 mg/dL) achieved targets for apoB/A-R <0.5 (21%) or TC/HDL-C <3.5 (42%). The percentages of intermediate-risk patients meeting both non-HDL-C and ratio goals varied; nonetheless, few met an aggressive apoB/A-R <0.6 (36%-50%) target.
Most high- and many intermediate-risk patients at non-HDL-C goals would require more aggressive treatment to reach the suggested apoB/A-R or TC/HDL-R targets. Whether this strategy yields superior outcomes merits future investigation.
载脂蛋白 B/A-1（apoB/A-R）和总/高密度脂蛋白胆固醇比值（TC/HDL-R）比成人治疗专家组（ATP）III 指南推荐的非高密度脂蛋白胆固醇（non-HDL-C）更能预测心血管（CV）结局。
评估采用我们提出的 apoB/A-R 和 TC/HDL-R 治疗算法对临床管理可能产生的影响。
我们对 2004 年 1 月至 2010 年 6 月期间到密歇根大学脂质诊所就诊的所有患者进行了图表回顾。ATP III 指南（包括 Framingham 风险评分）用于确定患者在就诊时是否达到非 HDL-C 目标。然后，我们评估如果遵循文献中推导的潜在 apoB/A-R 或 TC/HDL-R 目标的算法，后续管理是否会有所不同。
在患者（n=692）中，非 HDL-C、apoB/A-R 和 TC/HDL-R 的平均值分别为 192.2±85.8mg/dL、0.92±0.64 和 6.7±8.0。尽管与 apoB 中度相关（r=0.56，P<0.01），但非 HDL-C 与 apoB/A-R（r=0.20，P<0.01）和 TC/HDL-R（r=0.39，P<0.01）的相关性较差。大多数低危患者（<2 个危险因素；n=207）在非 HDL-C 目标（<190mg/dL）下也达到 apoB/A-R<0.9（79%）和 TC/HDL-R<6.0（92%）的目标。然而，少数高危患者（Framingham 风险评分>20%、心血管疾病或风险等同；n=307）在达到非 HDL-C 目标（<130mg/dL）时，未能达到 apoB/A-R<0.5（21%）或 TC/HDL-C<3.5（42%）的目标。达到非 HDL-C 和比值目标的中间风险患者的百分比各不相同；尽管如此，很少有患者达到激进的 apoB/A-R<0.6（36%-50%）目标。
大多数高危和许多中危患者在非 HDL-C 目标下需要更积极的治疗才能达到建议的 apoB/A-R 或 TC/HDL-R 目标。这种策略是否能产生更好的结果值得进一步研究。
