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Apolipoprotein B100 is a better treatment target than calculated LDL and non-HDL cholesterol in statin-treated

Handrean Soran1, Michael W France, See Kwok

  • 1Cardiovascular Research Group, School of Biomedicine, Core Technology Facility, 3rd Floor, University of Manchester, 46 Grafton Street, Manchester M13 9NT, UK. Handrean.Soran@cmft.nhs.uk

Annals of Clinical Biochemistry
|October 19, 2011
PubMed

Insights

Apolipoprotein B100 (apoB) is a more reliable target than LDL-C or non-HDL-C for statin therapy, especially in patients with high triglycerides. ApoB levels were higher than expected at cholesterol targets in a lipid clinic audit.

Area of Science:

  • Cardiovascular Medicine
  • Clinical Biochemistry
  • Pharmacology

Background:

  • Clinical trials suggest apolipoprotein B100 (apoB) is a superior target for statin therapy compared to calculated low-density lipoprotein cholesterol (c-LDL-C) or non-high-density lipoprotein cholesterol (non-HDL-C).
  • Limited data exist on achieving these targets in patients with severe hyperlipidaemia commonly seen in lipid clinics.

Purpose of the Study:

  • To audit the achievement of apoB, c-LDL-C, and non-HDL-C targets in patients with hyperlipidaemia treated with statins in a tertiary lipid clinic.
  • To compare measured apoB values against consensus apoB targets derived from c-LDL-C and non-HDL-C targets.

Main Methods:

  • Audit of 195 patients on statin therapy for over one year at a lipid clinic.
  • Measurement of total cholesterol, HDL-cholesterol, and triglycerides to calculate c-LDL-C and non-HDL-C.
  • Linear regression to determine average measured apoB at critical cholesterol target values and comparison with expert-derived consensus apoB values.

Main Results:

  • Measured apoB values were significantly higher than consensus apoB targets at both LDL-C (2.6 mmol L⁻¹) and non-HDL-C (3.4 mmol L⁻¹) targets.
  • The discrepancy was most pronounced for c-LDL-C in hypertriglyceridaemic patients and for non-HDL-C in non-hypertriglyceridaemic patients.
  • Using centile-derived consensus values accentuated these differences due to lower equivalent apoB values.

Conclusions:

  • Apolipoprotein B100 (apoB) provides a more consistent treatment target, independent of hypertriglyceridaemia levels.
  • Utilizing apoB as a target can overcome technical calculation issues associated with high triglyceride levels.
Abstract

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