Sniderman Allan D, Lamarche Benoit, Contois John H, de Graaf Jacqueline
aMike Rosenbloom Laboratory for Cardiovascular Research, McGill University Health Centre, Royal Victoria Hospital, Montreal bInstitute of Nutrition and Functional Foods, Laval University, Hochelaga, Quebec, Canada cSun Diagnostics, LLC, New Gloucester, Maine, USA dDepartment of Internal Medicine, Division of Vascular Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
Curr Opin Lipidol. 2014 Dec;25(6):461-7. doi: 10.1097/MOL.0000000000000127.
Conventional methods, comparing the concentration of cholesterol to particle number as indices of cardiovascular risk, have not produced consistent results, in large part, because they treat these variables as independent and unrelated. However, although highly correlated, apolipoprotein B particles may contain a normal mass of cholesterol or may be cholesterol-depleted or cholesterol-enriched. Discordance analysis compares the predictive power of LDL-C and non-HDL-C to apolipoprotein B and LDL particle numbers in patients in whom they differ, that is, in whom they are discordant. The advantage of discordance analysis is that the results are not diluted by concordant data in which risk predictions cannot differ.
The evidence, to date, consistently demonstrates that apolipoprotein B and LDL particle numbers are more accurate indices of cardiovascular risk than LDL-C or non-HDL-C.
Discordance analysis is a methodological advance that allows the clinical value of closely correlated variables to be determined and demonstrates that cardiovascular risk is more closely related to the number of atherogenic particles than to the total mass of cholesterol within them.
传统方法将胆固醇浓度与颗粒数量作为心血管风险指标进行比较，但并未得出一致结果，很大程度上是因为它们将这些变量视为独立且不相关的。然而，尽管载脂蛋白B颗粒高度相关，但可能含有正常量的胆固醇，也可能胆固醇含量不足或富集。不一致性分析比较了低密度脂蛋白胆固醇（LDL-C）和非高密度脂蛋白胆固醇（non-HDL-C）与载脂蛋白B及低密度脂蛋白颗粒数量在两者不同（即不一致）的患者中的预测能力。不一致性分析的优势在于结果不会被风险预测无差异的一致性数据所稀释。
迄今为止的证据一致表明，载脂蛋白B和低密度脂蛋白颗粒数量比LDL-C或non-HDL-C更能准确反映心血管风险。
不一致性分析是一种方法学上的进步，它能够确定密切相关变量的临床价值，并表明心血管风险与致动脉粥样硬化颗粒的数量比与其所含胆固醇的总量更密切相关。
