Department of Clinical Biochemistry, Jagiellonian University Medical College, Kraków, Poland.
Mie and Valeria Centre for Cardiovascular Prevention, McGill University Health Centre, Montreal, Canada.
Int J Cardiol. 2023 Nov 1;390:131150. doi: 10.1016/j.ijcard.2023.131150. Epub 2023 Jul 8.
The study compared the distribution of serum LDL-C, non-HDL-C, and apolipoprotein B (apoB) among participants of the NATPOL 2011 survey and analysed concordance/discordance of results in the context of the risk for atherosclerotic cardiovascular disease (ASCVD).
Serum levels of apoB, LDL-C, non-HDL-C and small dense LDL-C were measured/calculated in 2067-2098 survey participants. The results were compared between women and men, age groups and in relation to body mass index (BMI), fasting glucose and TG levels, and the presence of CVD. Percentile distribution of lipid levels and concordance/discordance analysis were based on medians and ESC/EAS 2019 target thresholds for ASCVD risk and on comparison of measured apoB levels and levels calculated from linear regression equations with serum LDL- C and non-HDL-C as independent variables.
Serum apoB, LDL-C and non-HDL-C were similarly related to sex, age, BMI, visceral obesity, cardiovascular disease, and fasting glucose and triglyceride levels. Serum apoB, LDL-C and non-HDL-C very high- and moderate- target thresholds were exceeded in 83%, 99% and 96.9% and in 41%, 75% and 63.7% of subjects, respectively. The incidence of the discordances between the results depended on the dividing values used and ranged from 0.2% to 45.2% of the respondents. Subjects with high apoB / low LDL-C/non-HDL-C discordance had features of metabolic syndrome.
Diagnostic discordances between apoB and LDL-C/non-HDL-C indicate limitations of serum LDL-C/non-HDL-C in ASCVD risk management. Due to the high apoB/low LDL-C/non-HDL-C discordance, obese/metabolic syndrome patients may benefit from replacing LDL-C/non-HDL-C by apoB in ASCVD risk assessment and lipid-lowering therapy.
本研究比较了 NATPOL 2011 调查参与者的血清 LDL-C、非 HDL-C 和载脂蛋白 B（apoB）分布，并分析了在动脉粥样硬化性心血管疾病（ASCVD）风险背景下结果的一致性/不一致性。
在 2067-2098 名调查参与者中测量/计算 apoB、LDL-C、非 HDL-C 和小而密 LDL-C 的血清水平。比较了女性和男性、年龄组以及与体重指数（BMI）、空腹血糖和甘油三酯水平以及心血管疾病的关系。基于中位数和 ESC/EAS 2019 年 ASCVD 风险的目标阈值以及基于线性回归方程测量 apoB 水平与 LDL-C 和非 HDL-C 作为独立变量的计算 apoB 水平，对血脂水平的百分位分布和一致性/不一致性进行了分析。
血清 apoB、LDL-C 和非 HDL-C 与性别、年龄、BMI、内脏肥胖、心血管疾病以及空腹血糖和甘油三酯水平密切相关。极高和中度目标阈值的血清 apoB、LDL-C 和非 HDL-C 超标率分别为 83%、99%和 96.9%，41%、75%和 63.7%的受试者超标。结果之间的不一致发生率取决于使用的划分值，范围从 0.2%到 45.2%的受访者。apoB/低 LDL-C/非 HDL-C 不一致的受试者具有代谢综合征的特征。
apoB 与 LDL-C/非 HDL-C 之间的诊断不一致表明血清 LDL-C/非 HDL-C 在 ASCVD 风险管理中的局限性。由于 apoB/低 LDL-C/非 HDL-C 不一致率高，肥胖/代谢综合征患者可能受益于用 apoB 替代 LDL-C/非 HDL-C 进行 ASCVD 风险评估和降脂治疗。
