Use of Emerging Lipoprotein Risk Factors in Assessment of Cardiovascular Risk

Grundy, Scott M.

doi:10.1001/jama.2012.6896

Cited by 19 publications

(15 citation statements)

References 17 publications

(10 reference statements)

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“…Those with CVD events during the study period were analyzed to determine if the alternative markers added significant predictive value. In an accompanying editorial, lipid expert Dr. Scott Grundy concluded that “apolipoproteins are of limited value in reclassifying individuals among arbitrary risk categories, i.e., low-risk, intermediate-risk, and high-risk” (20). Even when a particular test has been shown to add incremental improvement in predicting risk, there has not been sufficient evidence to use the test as a widespread screening tool.…”

Section: Evaluation and Treatment Of Patient With Hyperlipidemiamentioning

confidence: 99%

Hyperlipidemia as a Risk Factor for Cardiovascular Disease

Nelson

2013

Primary Care: Clinics in Office Practice

859

550

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Synopsis Elevated levels of blood lipids are well documented risk factors for cardiovascular disease. Current classification schemes and treatment levels for hyperlipidemia are based on the National Cholesterol Education Panel’s (NCEP) Adult Treatment Program-3 (ATP-III) guidelines. Statins are the preferred class of drugs to lower elevated low density lipoprotein cholesterol (LDL-C). There are other classes to augment or substitute for statins, such as ezetimibe, fibrates, niacin and dietary supplements. Extensive research over the last decade has raised the question whether or not ATP-III guidelines are sufficiently aggressive. New guidelines from ATP-IV are expected to be released in the near future, but in the meantime physicians are faced with uncertainty about how low to target LDL-C, whether to pharmacologically treat high density lipoprotein cholesterol (HDL-C) and triglyceride (TG) levels and how best to achieve target goals.

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Section: Evaluation and Treatment Of Patient With Hyperlipidemiamentioning

confidence: 99%

Hyperlipidemia as a Risk Factor for Cardiovascular Disease

Nelson

2013

Primary Care: Clinics in Office Practice

859

550

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“…Although some studies reported that apoB is superior to total cholesterol or LDL cholesterol in predicting CVD risk [74,75], there is a serious problem in the reproducibility and standardization of measuring apoB due to the significant size and epitope heterogeneity of this molecule [76]. Overall, compared with separate lipid-related CVD markers, HDL cholesterol appears to be better correlated with atherogenic lipoproteins and other cardiovascular risk factors because high HDL cholesterol itself strongly protects against CVD, while low HDL cholesterol is inversely correlated with levels of atherogenic lipoproteins and is associated with several cardiometabolic risk factors [77,78]. …”

Section: Ldl In Atherosclerosismentioning

confidence: 99%

Modified Low Density Lipoprotein and Lipoprotein-Containing Circulating Immune Complexes as Diagnostic and Prognostic Biomarkers of Atherosclerosis and Type 1 Diabetes Macrovascular Disease

Orekhov

Bobryshev

Sobenin

et al. 2014

IJMS

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In atherosclerosis; blood low-density lipoproteins (LDL) are subjected to multiple enzymatic and non-enzymatic modifications that increase their atherogenicity and induce immunogenicity. Modified LDL are capable of inducing vascular inflammation through activation of innate immunity; thus, contributing to the progression of atherogenesis. The immunogenicity of modified LDL results in induction of self-antibodies specific to a certain type of modified LDL. The antibodies react with modified LDL forming circulating immune complexes. Circulating immune complexes exhibit prominent immunomodulatory properties that influence atherosclerotic inflammation. Compared to freely circulating modified LDL; modified LDL associated with the immune complexes have a more robust atherogenic and proinflammatory potential. Various lipid components of the immune complexes may serve not only as diagnostic but also as essential predictive markers of cardiovascular events in atherosclerosis. Accumulating evidence indicates that LDL-containing immune complexes can also serve as biomarker for macrovascular disease in type 1 diabetes.

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“…Other population-based studies have confirmed this finding [3,4], including an analysis by the Emerging Risk Factor Collaboration of 68 long-term prospective studies involving 302,430 participants (12,785 cases) [5]. These data have led to the adoption of low HDL-C levels (defined as <40 mg/dL for males, <50 mg/dL for females) as a risk factor used in the assessment of an individual's risk for atherosclerotic cardiovascular disease [6,7], and have triggered the development of therapeutic approaches to raise HDL-C levels with the hope of improving cardiovascular disease (CVD) outcomes [8].…”

Section: Introductionmentioning

confidence: 96%

Underappreciated Opportunities for High-Density Lipoprotein Particles in Risk Stratification and Potential Targets of Therapy

Rosenson

Davidson

et al. 2015

Cardiovasc Drugs Ther

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The inverse relationship between high-density lipoprotein cholesterol (HDL-C) concentrations and coronary heart disease risk is well established. As a result, in recent years there have been significant resources focused on identifying therapies that raise HDL-C and ultimately reduce cardiovascular events. Unfortunately, a number of trials aimed at increasing HDL-C have failed to show improved outcomes, and hence, have cast doubt on the importance of HDL-C as a therapeutic target. HDL-C, however, is only one measure of HDL. HDL levels can also been estimated by quantifying apolipoprotein A-I (apoA-I) levels using enzyme immunoassay or by measuring HDL particle number (HDL-P) using nuclear magnetic resonance spectroscopy (NMR) or ion mobility. While these surrogate measures are correlated, they are not comparable. Lipoprotein-altering therapies have been shown to have different effects on HDL-C, apoA-I and HDL-P and several studies have demonstrated that HDL-P is a stronger predictor of coronary heart disease risk than HDL-C and/or apoA-I. This paper will review available evidence supporting the use of HDL-P as the biomarker of choice to assess the contribution of HDL to cardiovascular risk and as the primary goal of HDL-raising therapies.

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Use of Emerging Lipoprotein Risk Factors in Assessment of Cardiovascular Risk

Cited by 19 publications

References 17 publications

Hyperlipidemia as a Risk Factor for Cardiovascular Disease

Hyperlipidemia as a Risk Factor for Cardiovascular Disease

Modified Low Density Lipoprotein and Lipoprotein-Containing Circulating Immune Complexes as Diagnostic and Prognostic Biomarkers of Atherosclerosis and Type 1 Diabetes Macrovascular Disease

Underappreciated Opportunities for High-Density Lipoprotein Particles in Risk Stratification and Potential Targets of Therapy

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