Refining Lipoprotein Assessment in Diabetes
Refining Lipoprotein Assessment in Diabetes
Objective: To summarize the data that support the measurement of apolipoprotein B as an accurate reflection of low-density lipoprotein (LDL) particle number and an easily adapted parameter in clinical practice.
Methods: Study findings are reviewed and a flow chart is provided to guide lipid assessment in patients with dyslipidemia.
Results: Current treatment guidelines for lipid management emphasize LDL cholesterol as the primary treatment target in patients at high risk of cardiovascular events. However, LDL cholesterol is a poor surrogate for LDL particle number, particularly in patients with altered LDL composition, such as those with insulin resistance, metabolic syndrome, and type 2 diabetes. Direct measurement of LDL particle number or size is not practical because of methodology and cost considerations. A suggested alternative target in patients with hypertriglyceridemia is non– high-density lipoprotein (HDL) cholesterol. Abundant evidence suggests that even non-HDL cholesterol is an inadequate approximation of the LDL particle number in such patients. The flow chart emphasizes the need to continue achieving the well-established LDL-cholesterol goal, while also considering apolipoprotein B measurement in those with hypertriglyceridemia, rather than relying on the less accurate surrogate of non-HDL cholesterol, when targeting therapy in such patients.
Conclusion: Presented evidence supports the measurement of apolipoprotein B as a more accurate reflection of LDL particle number than non-HDL cholesterol, and it is an easily adapted parameter in clinical practice.
Introduction
Diabetes is the leading cause of cardiovascular morbidity and mortality around the world. In a large meta-analysis of 37 studies, the multivariate-adjusted relative risk for fatal coronary heart disease in persons with diabetes when compared with nondiabetic individuals was a highly significant 3.12 in women and 1.99 in men. Moreover, diabetes may lead to myocardial infarction at a much younger age in both men and women, as shown in a large population database encompassing more than 379 000 people with diabetes compared with more than 9 million people without diabetes. In this population, diabetes resulted in an approximate equivalent of 15 years of premature aging. This was corroborated in the recent analysis of the Framingham study cohort, which concluded that at age 50 years, diabetes confers a life expectancy reduction of 7.5 years in men and 8.2 years in women. Furthermore, in a multitrial analysis of more than 60 000 patients (of whom more than 10 600 had diabetes), patients with diabetes had a worse prognosis than patients without diabetes, with a 40% increase in 30-day mortality and a 33% increase in 1-year mortality.
This review summarizes the data that support the measurement of apolipoprotein B (apo B) as an accurate reflection of low-density lipoprotein (LDL) particle number, and a better predictor of cardiovascular risk, compared to LDL cholesterol and non-HDL cholesterol, and with easily adapted parameter in clinical practice.
Abstract and Introduction
AbstractObjective: To summarize the data that support the measurement of apolipoprotein B as an accurate reflection of low-density lipoprotein (LDL) particle number and an easily adapted parameter in clinical practice.
Methods: Study findings are reviewed and a flow chart is provided to guide lipid assessment in patients with dyslipidemia.
Results: Current treatment guidelines for lipid management emphasize LDL cholesterol as the primary treatment target in patients at high risk of cardiovascular events. However, LDL cholesterol is a poor surrogate for LDL particle number, particularly in patients with altered LDL composition, such as those with insulin resistance, metabolic syndrome, and type 2 diabetes. Direct measurement of LDL particle number or size is not practical because of methodology and cost considerations. A suggested alternative target in patients with hypertriglyceridemia is non– high-density lipoprotein (HDL) cholesterol. Abundant evidence suggests that even non-HDL cholesterol is an inadequate approximation of the LDL particle number in such patients. The flow chart emphasizes the need to continue achieving the well-established LDL-cholesterol goal, while also considering apolipoprotein B measurement in those with hypertriglyceridemia, rather than relying on the less accurate surrogate of non-HDL cholesterol, when targeting therapy in such patients.
Conclusion: Presented evidence supports the measurement of apolipoprotein B as a more accurate reflection of LDL particle number than non-HDL cholesterol, and it is an easily adapted parameter in clinical practice.
Introduction
Diabetes is the leading cause of cardiovascular morbidity and mortality around the world. In a large meta-analysis of 37 studies, the multivariate-adjusted relative risk for fatal coronary heart disease in persons with diabetes when compared with nondiabetic individuals was a highly significant 3.12 in women and 1.99 in men. Moreover, diabetes may lead to myocardial infarction at a much younger age in both men and women, as shown in a large population database encompassing more than 379 000 people with diabetes compared with more than 9 million people without diabetes. In this population, diabetes resulted in an approximate equivalent of 15 years of premature aging. This was corroborated in the recent analysis of the Framingham study cohort, which concluded that at age 50 years, diabetes confers a life expectancy reduction of 7.5 years in men and 8.2 years in women. Furthermore, in a multitrial analysis of more than 60 000 patients (of whom more than 10 600 had diabetes), patients with diabetes had a worse prognosis than patients without diabetes, with a 40% increase in 30-day mortality and a 33% increase in 1-year mortality.
This review summarizes the data that support the measurement of apolipoprotein B (apo B) as an accurate reflection of low-density lipoprotein (LDL) particle number, and a better predictor of cardiovascular risk, compared to LDL cholesterol and non-HDL cholesterol, and with easily adapted parameter in clinical practice.