Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, USA.
Lipoprotein Metabolism Laboratory, Translational Vascular Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Bldg. 10/Rm. 2C433, Bethesda, MD, 20892, USA.
Lipids Health Dis. 2021 Nov 27;20(1):170. doi: 10.1186/s12944-021-01585-8.
Dyslipoproteinemias can be classified by their distinct lipoprotein patterns, which helps determine atherosclerotic cardiovascular disease (ASCVD) risk and directs lipid management but this has required advanced laboratory testing.
To develop a new algorithm for classifying lipoprotein disorders that only relies on the standard lipid panel.
Lipid thresholds for defining the different lipoprotein phenotypes were derived for Non-High-Density Lipoprotein-Cholesterol (NonHDL-C) and Triglycerides (TG) to be concordant when possible with the current US Multi-Society guidelines for blood cholesterol management.
The new classification method categorizes patients into all the classical Fredrickson-like phenotypes except for Type III dysbetalipoproteinemia. In addition, a new hypolipidemic phenotype (Type VI) due to genetic mutations in apoB-metabolism is described. The validity of the new algorithm was confirmed by lipid analysis by NMR (N = 11,365) and by concordance with classification by agarose gel electrophoresis/beta-quantification (N = 5504). Furthermore, based on the Atherosclerosis Risk in Communities (ARIC) cohort (N = 14,742), the lipoprotein phenotypes differ in their association with ASCVD (TypeV>IIb > IVb > IIa > IVa > normolipidemic) and can be used prognostically as risk enhancer conditions in the management of patients.
We describe a clinically useful lipoprotein phenotyping system that is only dependent upon the standard lipid panel. It, therefore, can be easily implemented for increasing compliance with current guidelines and for improving the care of patients at risk for ASCVD.
根据不同的脂蛋白模式对脂代谢紊乱进行分类有助于确定动脉粥样硬化性心血管疾病（ASCVD）风险，并指导血脂管理，但这需要先进的实验室检测。
开发一种仅依赖标准血脂谱即可对脂蛋白紊乱进行分类的新方法。
为了与当前美国多学会血液胆固醇管理指南一致，我们推导出了非高密度脂蛋白胆固醇（NonHDL-C）和甘油三酯（TG）的不同脂蛋白表型的血脂阈值。
新的分类方法将患者分为除 III 型脂蛋白血症外的所有经典弗雷德里克森样表型。此外，还描述了一种新的由于载脂蛋白 B 代谢基因突变引起的低脂蛋白血症表型（VI 型）。通过 NMR（N=11365）的脂质分析和琼脂糖凝胶电泳/β定量（N=5504）的分类与新算法的一致性验证了该算法的有效性。此外，基于动脉粥样硬化风险社区（ARIC）队列（N=14742），脂蛋白表型与 ASCVD 的相关性不同（V 型>IIb>IVb>IIa>IVa>正常脂质血症），并且可以作为预测风险的增强条件用于患者的管理。
我们描述了一种仅依赖于标准血脂谱的临床有用的脂蛋白表型系统。因此，它可以很容易地实施，以提高对当前指南的依从性，并改善 ASCVD 风险患者的护理。
