Sílvia Cristina de Sousa Paredes. Endocrinology Department, Hospital de Braga, Sete Fontes, São Victor, 4710-243, Braga, Portugal.
Liliana Cecília Martins da Fonseca. Endocrinology Department, Centro Hospitalar e Universitário do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal.
Sci Rep. 2019 Aug 13;9(1):11792. doi: 10.1038/s41598-019-48120-5.
Low-density-lipoprotein cholesterol (LDL-c) guides lipid-lowering therapy, although other lipid parameters could better reflect cardiovascular disease (CVD) risk. Discordance between these parameters and LDL-c has not been evaluated in metabolic syndrome (MetS) patients. We characterized a comprehensive lipid profile in 177 MetS patients. The 2016 ESC/EAS Guidelines for the Management of Dyslipidemias were used to define LDL-c targets. The atherogenic lipoprotein profile was compared in patients with LDL-c within and above the target. Only 34.4% (61) of patients had mean LDL-c levels within the guidelines and patients with LDL-c above target presented significantly elevated levels of Apolipoprotein B (ApoB), non-high-density lipoprotein cholesterol (non-HDL-c) and oxidized LDL-c. In patients with LDL-c within target, 25%, 31% and 49% presented levels above the recommended range for ApoB, non-HDL-c and oxidized LDL-c, respectively. Patients presented a strong association of LDL-c and non-HDL-c (r = 0.796), ApoB (r = 0.749) and oxidized LDL-c (r = 0.452). Similarly, non-HDL-c was strongly correlated with ApoB (r = 0.857) and oxidized-LDL-c (r = 0.555). The logistic regression model evidenced higher triglycerides and HDL-c and lower ApoB as predictors of having LDL-c within target. Reliance solely on LDL-c could result in missed opportunities for CVD risk reduction. ApoB, oxidized LDL-c, and particularly non-HDL-c, could be valuable parameters to estimate the CVD risk of MetS patients and have the potential to be targeted therapeutically.
低密度脂蛋白胆固醇（LDL-c）指导降脂治疗，但其他脂质参数可能更好地反映心血管疾病（CVD）风险。尚未在代谢综合征（MetS）患者中评估这些参数与 LDL-c 之间的差异。我们对 177 例 MetS 患者进行了全面的脂质谱特征分析。采用 2016 年 ESC/EAS 血脂异常管理指南来定义 LDL-c 目标。比较了 LDL-c 在目标内和目标上的 MetS 患者的致动脉粥样硬化脂蛋白谱。只有 34.4%（61 例）的患者 LDL-c 水平符合指南要求，而 LDL-c 目标以上的患者载脂蛋白 B（ApoB）、非高密度脂蛋白胆固醇（non-HDL-c）和氧化 LDL-c 水平显著升高。在 LDL-c 目标内的患者中，分别有 25%、31%和 49%的患者 ApoB、non-HDL-c 和氧化 LDL-c 的水平超过推荐范围。患者 LDL-c 与 non-HDL-c（r=0.796）、ApoB（r=0.749）和氧化 LDL-c（r=0.452）之间存在强烈的关联。同样，non-HDL-c 与 ApoB（r=0.857）和氧化-LDL-c（r=0.555）之间也存在强烈的相关性。Logistic 回归模型表明，较高的甘油三酯和 HDL-c 以及较低的 ApoB 是 LDL-c 在目标内的预测因素。仅仅依赖 LDL-c 可能会错失降低 CVD 风险的机会。ApoB、氧化 LDL-c，尤其是 non-HDL-c，可能是评估 MetS 患者 CVD 风险的有价值参数，并有可能成为治疗的靶点。
