Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.
Sorbonne Université, INSERM UMR1166, Lipidology and Cardiovascular Prevention Unit, Department of Nutrition, APHP, Hôpital Pitié-Salpètriêre, 47/83 Boulevard de L'Hôpital, 75013, Paris, France.
Curr Atheroscler Rep. 2024 Sep;26(9):537-548. doi: 10.1007/s11883-024-01225-3. Epub 2024 Jul 5.
This review aims to assess the variability in considering hypercholesterolemia for cardiovascular risk stratification in the general population. Recent literature on the integration of hypercholesterolemia into clinical risk scores and its interaction with other risk factors will be explored.
The impact of hypercholesterolemia on risk estimation varies among different cardiovascular risk calculators. Elevated lipid levels during early life stages contribute to atherosclerotic plaque development, influencing disease severity despite later treatment initiation. The interplay between low-density lipoprotein cholesterol (LDLc), inflammatory markers and non-LDL lipid parameters enhances cardiovascular risk stratification. Studies have also examined the role of coronary artery calcium (CAC) score as a negative risk marker in populations with severe hypercholesterolemia. Furthermore, polygenic risk scores (PRS) may aid in diagnosing non-monogenic hypercholesterolemia, refining cardiovascular risk stratification and guiding lipid-lowering therapy strategies. Understanding the heterogeneity in risk estimation and the role of emerging biomarkers and imaging techniques is crucial for optimizing cardiovascular risk prediction and guiding personalized treatment strategies in individuals with hypercholesterolemia.
本综述旨在评估在普通人群中进行心血管风险分层时对高胆固醇血症的考虑的变异性。将探讨高胆固醇血症纳入临床风险评分的最新文献及其与其他危险因素的相互作用。
高胆固醇血症对不同心血管风险计算器的风险估计的影响不同。生命早期阶段升高的血脂水平有助于动脉粥样硬化斑块的发展，尽管后来开始治疗，但仍会影响疾病的严重程度。低密度脂蛋白胆固醇（LDLc）、炎症标志物和非 LDL 脂质参数之间的相互作用增强了心血管风险分层。研究还检查了冠状动脉钙（CAC）评分在严重高胆固醇血症人群中作为阴性风险标志物的作用。此外，多基因风险评分（PRS）可能有助于诊断非单基因高胆固醇血症，从而完善心血管风险分层并指导降脂治疗策略。了解风险估计的异质性以及新兴生物标志物和成像技术的作用对于优化心血管风险预测和指导高胆固醇血症患者的个体化治疗策略至关重要。
