Divisions of Preventive (S.M., J.E.B., P.M.R.) and Cardiovascular Medicine (S.M., P.M.R.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Circulation. 2014 Feb 4;129(5):553-61. doi: 10.1161/CIRCULATIONAHA.113.005873. Epub 2013 Dec 17.
Low-density lipoprotein cholesterol (LDL-C) is the traditional measure of risk attributable to LDL. Non-high-density lipoprotein cholesterol (NHDL-C), apolipoprotein B (apoB), and LDL particle number (LDL-P) are alternative measures of LDL-related risk. However, the clinical utility of these measures may only become apparent among individuals for whom levels are inconsistent (discordant) with LDL-C.
LDL-C was measured directly, NHDL-C was calculated, apoB was measured with immunoassay, and LDL-P was measured with nuclear magnetic resonance spectroscopy among 27 533 healthy women (median follow-up 17.2 years; 1070 incident coronary events). Participants were grouped by median LDL-C (121 mg/dL) and each of NHDL-C, apoB, and LDL-P. Discordance was defined as LDL-C greater than or equal to the median and the alternative measure less than the median, or vice versa. Despite high LDL-C correlations with NHDL-C, apoB, and LDL-P (r=0.910, 0.785, and 0.692; all P<0.0001), prevalence of LDL-C discordance as defined by median cut points was 11.6%, 18.9%, and 24.3% for NHDL-C, apoB, and LDL-P, respectively. Among women with LDL-C less than the median, coronary risk was underestimated for women with discordant (greater than or equal to the median) NHDL-C (age-adjusted hazard ratio, 2.92; 95% confidence interval, 2.33-3.67), apoB (2.48, 2.01-3.07), or LDL-P (2.32, 1.88-2.85) compared with women with concordant levels. Conversely, among women with LDL-C greater than or equal to the median, risk was overestimated for women with discordant (less than the median) NHDL-C (0.40, 0.29-0.57), apoB (0.34, 0.26-0.46), or LDL-P (0.42, 0.33-0.53). After multivariable adjustment for potentially mediating factors, including HDL cholesterol and triglycerides, coronary risk remained underestimated or overestimated by ≈20% to 50% for women with discordant levels.
For women with discordant LDL-related measures, coronary risk may be underestimated or overestimated when LDL-C alone is used.
http://www.clinicaltrials.gov. Unique identifier: NCT00000479.
低密度脂蛋白胆固醇（LDL-C）是 LDL 所致风险的传统衡量指标。非高密度脂蛋白胆固醇（NHDL-C）、载脂蛋白 B（apoB）和 LDL 颗粒数（LDL-P）是 LDL 相关风险的替代衡量指标。然而，这些指标的临床实用性可能仅在 LDL-C 水平不一致（不一致）的个体中显现出来。
在 27533 名健康女性中（中位随访 17.2 年；1070 例冠心病事件），直接测量 LDL-C，计算 NHDL-C，用免疫测定法测量 apoB，用核磁共振光谱法测量 LDL-P。参与者按 LDL-C 中位数（121mg/dL）和 NHDL-C、apoB 和 LDL-P 中位数进行分组。不一致定义为 LDL-C 大于或等于中位数，而替代指标小于中位数，或反之亦然。尽管 LDL-C 与 NHDL-C、apoB 和 LDL-P 高度相关（r=0.910、0.785 和 0.692；所有 P<0.0001），但根据中位数切点定义的 LDL-C 不一致的患病率分别为 NHDL-C、apoB 和 LDL-P 的 11.6%、18.9%和 24.3%。在 LDL-C 低于中位数的女性中，与具有一致水平的女性相比，NHDL-C（年龄调整后的危险比，2.92；95%置信区间，2.33-3.67）、apoB（2.48，2.01-3.07）或 LDL-P（2.32，1.88-2.85）不一致的女性患冠心病的风险被低估。相反，在 LDL-C 大于或等于中位数的女性中，与具有一致水平的女性相比，NHDL-C（0.40，0.29-0.57）、apoB（0.34，0.26-0.46）或 LDL-P（0.42，0.33-0.53）不一致的女性的风险被高估。在对可能的中介因素（包括高密度脂蛋白胆固醇和甘油三酯）进行多变量调整后，对于具有不一致水平的女性，冠心病风险仍被低估或高估了约 20%至 50%。
对于具有不一致的 LDL 相关指标的女性，当仅使用 LDL-C 时，冠心病风险可能被低估或高估。
