Impact of improved low-density lipoprotein cholesterol assessment on guideline classification in the modern treatment era—Results from a racially diverse Brazilian cross-sectional study

Vincent A. Pallazola, Vasanth Sathiyakumar, Oluseye Ogunmoroti, Oluwaseun Fashanu, Steven R. Jones, Raul D. Santos, Peter P. Toth, Marcio S. Bittencourt, Bruce B. Duncan, Paulo A. Lotufo, Isabela M. Bensenor, Michael J. Blaha, Seth S. Martin

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The Martin/Hopkins low-density lipoprotein cholesterol equation (LDL-CN) was previously demonstrated as more accurate than Friedewald LDL-C estimation (LDL-CF) in a North American database not able to take race into account. Objectives: We hypothesized that LDL-CN would be more accurate than LDL-CF and correlate better with LDL particle number (LDL-P) in a racially diverse Brazilian cohort. Methods: We performed a cross-sectional analysis of 4897 participants in the Brazilian Longitudinal Study of Adult Health, assessing LDL-CF and LDL-CN accuracy via overlap with ultracentrifugation-based measurement among clinical guideline LDL-C categories as well as mg/dL and percent error differences. We analyzed by triglyceride categories and correlated LDL-C estimation with LDL-P. Results: LDL-CN demonstrated improved accuracy at 70 to <100 and <70 mg/dL (P < .001), with large errors ≥20 mg/dL about 9 times more frequent in LDL-CF at LDL-C <70 mg/dL, mainly due to underestimation. Among individuals with LDL-C <70 mg/dL and triglycerides ≥150 mg/dL, 65% vs 100% of ultracentrifugation-based low-density lipoprotein cholesterol calculation fell within appropriate categories of estimated LDL-CF and LDL-CN, respectively (P < .001). Similar results were observed when analyzed for age, sex, and race. Participants at LDL-C <70 and 70 to <100 mg/dL with discordantly elevated LDL-CN vs LDL-CF had a 58.5% and 41.5% higher LDL-P than those with concordance (P < .0001), respectively. Conclusions: In a diverse Brazilian cohort, LDL-CN was more accurate than LDL-CF at low LDL-C and high triglycerides. LDL-CN may avoid underestimation of LDL-C and better reflect atherogenic lipid burden in low particle size, high particle count states.

Original languageEnglish (US)
Pages (from-to)804-811.e2
JournalJournal of clinical lipidology
Volume13
Issue number5
DOIs
StatePublished - Sep 1 2019

Keywords

  • Cardiovascular prevention
  • Cholesterol
  • Friedewald equation
  • Low-density lipoprotein particle number
  • Martin/Hopkins equation
  • Precision medicine
  • Triglycerides

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Nutrition and Dietetics
  • Cardiology and Cardiovascular Medicine

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