TY - JOUR
T1 - The spectrum of type III hyperlipoproteinemia
AU - Sniderman, Allan D.
AU - de Graaf, Jacqueline
AU - Thanassoulis, George
AU - Tremblay, André J.
AU - Martin, Seth S.
AU - Couture, Patrick
N1 - Funding Information:
PC and AJT have received funding in the last 5 years from the Canadian Institutes for Health Research, Agriculture and Agri-Food Canada (Growing Forward program supported by the Dairy Farmers of Canada (DFC), Canola Council of Canada, Flax Council of Canada, Dow Agrosciences), Dairy Research Institute, Dairy Australia, Danone Institute, Merck, Pfizer, Atrium Innovations and Kaneka Corporation
Funding Information:
SSM is listed as a co-inventor on a pending patent filed by Johns Hopkins University for an algorithm to estimate low-density lipoprotein cholesterol. SSM has served on scientific advisory boards for Quest Diagnostics, Sanofi/Regeneron, Amgen, and Akcea Therapeutics. SSM has received research support from the PJ Schafer Cardiovascular Research Fund, the David and June Trone Family Foundation, the American Heart Association, the Aetna Foundation, CASCADE FH, the Maryland Innovation Initiative, Google, and Apple.
Publisher Copyright:
© 2018 National Lipid Association
PY - 2018/11/1
Y1 - 2018/11/1
N2 - Background: Type III hyperlipoproteinemia is a highly atherogenic dyslipoproteinemia characterized by hypercholesterolemia and hypertriglyceridemia due to markedly increased numbers of cholesterol-enriched chylomicron and very-low-density lipoprotein (VLDL) remnant lipoprotein particles. Type III can be distinguished from mixed hyperlipidemia based on a simple diagnostic algorithm, which involves total cholesterol, triglycerides, and apolipoprotein B (apoB). However, apoB is not measured routinely. Objective: The objective of the present study was to determine if patients with type III could be distinguished from mixed hyperlipidemia based on lipoprotein lipids. Methods: Classification was based first on total cholesterol and triglyceride and then on the apoB diagnostic algorithm using apoB plus total cholesterol plus triglycerides, and validated by sequential ultracentrifugation. Four hundred and forty normals, 637 patients with hypertriglyceridemia, and 714 with hypertriglyceridemia and hypercholesterolemia were studied. Plasma lipoproteins were separated by sequential ultracentrifugation and heparin-manganese precipitation. Cholesterol, triglyceride, and apoB were measured in plasma and isolated lipoprotein fractions. Results: Of the 1351 patients with hypertriglyceridemia, 49 had type III hyperlipoproteinemia, as diagnosed by the apoB algorithm and validated by ultracentrifugation. Plasma triglycerides were higher in the type III subjects: 4.16 mmol/L (3.35–6.08, 25th–75th percentile), but there was considerable overlap with the hypertriglyceridemic subjects 2.65 mmol/L (1.91–4.20, 25th–75th percentile) and the combined hyperlipidemic subjects 3.02 mmol/L (2.07–5.32, 25th–75th percentile). Similarly, total cholesterol was 4.79 mmol/L (4.31–5.58, 25th–75th percentile) for type III vs 5.5 mmol/L (4.64–5.78, 25th–75th percentile) and 7.02 mmol/L (6.39–7.96, 25th–75th percentile), respectively. By contrast, as identified by the apoB algorithm, the VLDL-C/TG, VLDL-C/VLDL-TG, VLDL-C/VLDL apoB, and VLDL apoB/LDL apoB ratios were all higher in type III than in the other hypertriglyceridemic dyslipoproteinemias with the exception of type V as diagnosed by the apoB algorithm. Conclusion: Cholesterol and triglycerides cannot reliably distinguish type III hyperlipoproteinemia from mixed hyperlipidemia. Adding apoB and applying the apoB algorithm makes reliable diagnosis possible and easy. However, unless apoB is introduced into routine clinical care, type III hyperlipoproteinemia will often not be recognized. Given the cardiovascular risk associated with type III and its responsiveness to treatment, this should not be acceptable.
AB - Background: Type III hyperlipoproteinemia is a highly atherogenic dyslipoproteinemia characterized by hypercholesterolemia and hypertriglyceridemia due to markedly increased numbers of cholesterol-enriched chylomicron and very-low-density lipoprotein (VLDL) remnant lipoprotein particles. Type III can be distinguished from mixed hyperlipidemia based on a simple diagnostic algorithm, which involves total cholesterol, triglycerides, and apolipoprotein B (apoB). However, apoB is not measured routinely. Objective: The objective of the present study was to determine if patients with type III could be distinguished from mixed hyperlipidemia based on lipoprotein lipids. Methods: Classification was based first on total cholesterol and triglyceride and then on the apoB diagnostic algorithm using apoB plus total cholesterol plus triglycerides, and validated by sequential ultracentrifugation. Four hundred and forty normals, 637 patients with hypertriglyceridemia, and 714 with hypertriglyceridemia and hypercholesterolemia were studied. Plasma lipoproteins were separated by sequential ultracentrifugation and heparin-manganese precipitation. Cholesterol, triglyceride, and apoB were measured in plasma and isolated lipoprotein fractions. Results: Of the 1351 patients with hypertriglyceridemia, 49 had type III hyperlipoproteinemia, as diagnosed by the apoB algorithm and validated by ultracentrifugation. Plasma triglycerides were higher in the type III subjects: 4.16 mmol/L (3.35–6.08, 25th–75th percentile), but there was considerable overlap with the hypertriglyceridemic subjects 2.65 mmol/L (1.91–4.20, 25th–75th percentile) and the combined hyperlipidemic subjects 3.02 mmol/L (2.07–5.32, 25th–75th percentile). Similarly, total cholesterol was 4.79 mmol/L (4.31–5.58, 25th–75th percentile) for type III vs 5.5 mmol/L (4.64–5.78, 25th–75th percentile) and 7.02 mmol/L (6.39–7.96, 25th–75th percentile), respectively. By contrast, as identified by the apoB algorithm, the VLDL-C/TG, VLDL-C/VLDL-TG, VLDL-C/VLDL apoB, and VLDL apoB/LDL apoB ratios were all higher in type III than in the other hypertriglyceridemic dyslipoproteinemias with the exception of type V as diagnosed by the apoB algorithm. Conclusion: Cholesterol and triglycerides cannot reliably distinguish type III hyperlipoproteinemia from mixed hyperlipidemia. Adding apoB and applying the apoB algorithm makes reliable diagnosis possible and easy. However, unless apoB is introduced into routine clinical care, type III hyperlipoproteinemia will often not be recognized. Given the cardiovascular risk associated with type III and its responsiveness to treatment, this should not be acceptable.
KW - Diagnosis
KW - Dyslipoproteinemia
KW - Type III hyperlipoproteinemia
KW - apoB
UR - http://www.scopus.com/inward/record.url?scp=85054560770&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85054560770&partnerID=8YFLogxK
U2 - 10.1016/j.jacl.2018.09.006
DO - 10.1016/j.jacl.2018.09.006
M3 - Article
C2 - 30318453
AN - SCOPUS:85054560770
VL - 12
SP - 1383
EP - 1389
JO - Journal of Clinical Lipidology
JF - Journal of Clinical Lipidology
SN - 1933-2874
IS - 6
ER -