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. 2019 Sep-Oct;13(5):804-811.e2.
doi: 10.1016/j.jacl.2019.07.002. Epub 2019 Jul 9.

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  1 , Vasanth Sathiyakumar  1 , Oluseye Ogunmoroti  1 , Oluwaseun Fashanu  1 , Steven R Jones  1 , Raul D Santos  2 , Peter P Toth  3 , Marcio S Bittencourt  4 , Bruce B Duncan  5 , Paulo A Lotufo  4 , Isabela M Bensenor  4 , Michael J Blaha  1 , Seth S Martin  6
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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 et al. J Clin Lipidol. 2019 Sep-Oct.

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.

Keywords: Cardiovascular prevention; Cholesterol; Friedewald equation; Low-density lipoprotein particle number; Martin/Hopkins equation; Precision medicine; Triglycerides.

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