TY - JOUR
T1 - 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
AU - Pallazola, Vincent A.
AU - Sathiyakumar, Vasanth
AU - Ogunmoroti, Oluseye
AU - Fashanu, Oluwaseun
AU - Jones, Steven R.
AU - Santos, Raul D.
AU - Toth, Peter P.
AU - Bittencourt, Marcio S.
AU - Duncan, Bruce B.
AU - Lotufo, Paulo A.
AU - Bensenor, Isabela M.
AU - Blaha, Michael J.
AU - Martin, Seth S.
N1 - Funding Information:
Conflict of interest: V.A.P., V.S., O.O., O.F., I.M.B., B.B.D., and P.A.L. have no conflict of interest to declare. S.R.J. was the co-inventor for a method to estimate LDL cholesterol levels, has patent application pending, and received funding from the David and June Trone Family Foundation. R.D.S. served as a consultant in Amgen, Astra Zeneca, Akcea, Novo-Nordisk, and Sanofi/Regeneron, was a member of speakers bureau at Amgen, Astra Zeneca, Biolab, Merck, and Sanofi/Regeneron and received research grants from Amgen, Esperion, Kowa, and Sanofi/Regeneron. P.P.T. was a member of the speakers bureau and was a consultant/member of advisory board at Amarin, Akcea, Amgen, Kowa, Merck, Nova Nordisk, Regeneron, and Sanofi. M.S.B. receives speaker fees from Boston Scientific and research grants from Sanofi. M.J.B. receives grants from NIH, FDA, AHA, Aetna Foundation, Amgen Foundation and was a member of advisory Board for Amgen, Sanofi, Regeneron, Novartis, Medicure, MedImmune, Akcea, and Novo Nordisk. S.S.M. was a consultant/member of advisory board for Sanofi/Regeneron, Amgen, Quest Diagnostics, Akcea, Novo Nordisk, Esperion, was a co-inventor for a method to estimate LDL cholesterol levels, and has patent application pending.
Funding Information:
The ELSA-Brasil study was supported by the Brazilian Ministry of Health (Science and Technology Department) and the Brazilian Ministry of Science and Technology ( Financiadora de Estudos e Projetos and CNPq National Research Council; grants 01 06 0010.00 ; RS,01 06 0212.00 BA , 01 06 0300.00 ES , 01 06 0278.00 MG , 01 06 0115.00 SP , and 01 06 0071.00 RJ ). The funding agency did not have any role in study design, analysis, or interpretation.
PY - 2019/9/1
Y1 - 2019/9/1
N2 - 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.
AB - 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.
KW - Cardiovascular prevention
KW - Cholesterol
KW - Friedewald equation
KW - Low-density lipoprotein particle number
KW - Martin/Hopkins equation
KW - Precision medicine
KW - Triglycerides
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U2 - 10.1016/j.jacl.2019.07.002
DO - 10.1016/j.jacl.2019.07.002
M3 - Article
C2 - 31383603
AN - SCOPUS:85075543942
VL - 13
SP - 804-811.e2
JO - Journal of Clinical Lipidology
JF - Journal of Clinical Lipidology
SN - 1933-2874
IS - 5
ER -