在新的更积极的血脂指南背景下，非高密度脂蛋白胆固醇（non-HDL-C）和载脂蛋白B（apoB）目标值的效用
Utility of non-HDL-C and apoB targets in the context of new more aggressive lipid guidelines.
作者信息
Quispe Renato, Brownstein Adam J, Sathiyakumar Vasanth, Park Jihwan, Chang Blair, Sajja Aparna, Guallar Eliseo, Lazo Mariana, Jones Steven R, Martin Seth S
机构信息
Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Hospital, 600 N. Wolfe St, Carnegie 591, Baltimore 21287 MD, United States.
Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore MD, United States.
出版信息
Am J Prev Cardiol. 2021 May 29;7:100203. doi: 10.1016/j.ajpc.2021.100203. eCollection 2021 Sep.
OBJECTIVE
Major guidelines recommend the use of secondary targets, such as non-HDL-C and apoB, to further reduce cardiovascular risk. We aimed to evaluate the proportion at which newer, more aggressive secondary lipid targets are exceeded in patients with LDL-C < 70 mg/dL estimated by Friedewald (LDLf-C) and Martin/Hopkins equations (LDLm-C).
METHODS
We analyzed patients from the Very Large Database of Lipids with fasting lipids and estimated LDL-C <70 mg/dL by the Friedewald equation and Martin/Hopkins algorithm. Patients were categorized into three groups: LDL-C <40, 40-54 and 55-69 mg/dL. We calculated the proportion of patients with non-HDL-C and apoB above high-risk targets (non-HDL-C ≥ 100 and apoB ≥ 80mg/dL) for those with LDL-C 55-69 mg/dL and very high-risk targets (non-HDL-C ≥ 85 and apoB ≥ 65mg/dL) for those with LDL-C < 40 mg/dL and 40-54 mg/dL.
RESULTS
In patients with LDLf-C < 40 mg/dL, ~8 and ~4% did not meet high-risk secondary targets and ~21 and 25% did not meet very high-risk secondary targets for non-HDL-C and apoB, respectively. However, in patients with LDLm-C < 40 mg/dL <1% did not meet high-risk targets, while only 3% did not meet the very-high risk secondary target for apoB and none exceeded the very-high risk secondary target for non-HDL-C. Among individuals with LDL-C< 40 mg/dL, there were increasing proportions of individuals not meeting the very high-risk secondary apoB target at greater triglyceride levels, reaching up to ~19% using LDLm-C compared to ~60% using LDLf-C when triglyceride levels were 200-399 mg/dL. There were higher proportions of individuals not meeting high and very-high risk targets as triglyceride levels increased among those with LDL-C 40-54 and 55-69 mg/dL.
CONCLUSION
In a large, US cross-sectional sample of individuals with LDL-C < 70 mg/dL, secondary non-HDL-C and apoB targets overall provide modest utility. However, attainment of very high-risk cutpoints for non-HDL-C and apoB is not achieved in a significant fraction of patients with triglycerides 200-399 mg/dL, even when using a more accurate calculation of LDL-C.
目的
主要指南推荐使用次要目标，如非高密度脂蛋白胆固醇（non-HDL-C）和载脂蛋白B（apoB），以进一步降低心血管风险。我们旨在评估通过Friedewald公式（LDLf-C）和Martin/Hopkins公式（LDLm-C）估算的低密度脂蛋白胆固醇（LDL-C）<70mg/dL的患者中，超过更新的、更严格的次要血脂目标的比例。
方法
我们分析了来自超大型血脂数据库的患者，这些患者有空腹血脂数据，且通过Friedewald公式和Martin/Hopkins算法估算的LDL-C<70mg/dL。患者被分为三组：LDL-C<40mg/dL、40 - 54mg/dL和55 - 69mg/dL。我们计算了LDL-C为55 - 69mg/dL的患者中，非HDL-C和apoB高于高危目标（非HDL-C≥100mg/dL且apoB≥80mg/dL）的比例，以及LDL-C<40mg/dL和40 - 54mg/dL的患者中，非HDL-C和apoB高于极高危目标（非HDL-C≥85mg/dL且apoB≥65mg/dL）的比例。
结果
在LDLf-C<40mg/dL的患者中，分别约有8%和4%未达到高危次要目标，约21%和25%未达到非HDL-C和apoB的极高危次要目标。然而，在LDLm-C<40mg/dL的患者中，<1%未达到高危目标，而只有3%未达到apoB的极高危次要目标，且无人超过非HDL-C的极高危次要目标。在LDL-C<40mg/dL的个体中，甘油三酯水平越高，未达到apoB极高危次要目标的个体比例越高，当甘油三酯水平为200 - 399mg/dL时，使用LDLm-C计算时这一比例高达约19%，而使用LDLf-C计算时约为60%。在LDL-C为40 - 54mg/dL和55 - 69mg/dL的个体中，随着甘油三酯水平升高，未达到高危和极高危目标的个体比例更高。
结论
在美国一个LDL-C<70mg/dL的大型横断面样本中，次要的非HDL-C和apoB目标总体效用不大。然而，即使使用更准确的LDL-C计算方法，仍有相当一部分甘油三酯水平为200 - 399mg/dL的患者未达到非HDL-C和apoB的极高危切点。
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