Advanced Lipid Thinking Prior to Incorporating Advanced Lipid Testing
Kent Brummel1, Nilay Shah2, Neil J Stone2
1University of Chicago, Chicago, Il.
Insights
Advanced lipid testing refines atherosclerotic cardiovascular disease risk assessment. Utilizing factors like Apolipoprotein B and lipoprotein (a) helps personalize treatment decisions for better cardiovascular event prevention.
Area of Science:
- Cardiology
- Clinical Lipidology
- Preventive Medicine
Background:
- Lipid profiles are crucial for estimating atherosclerotic cardiovascular disease (ASCVD) risk and guiding treatment.
- The 2018 cholesterol guidelines recommend advanced lipid testing for specific patient groups.
- Risk stratification is essential for effective ASCVD prevention strategies.
Purpose of the Study:
- To outline the role of advanced lipid testing in ASCVD risk assessment.
- To detail how new guidelines inform the use of advanced lipid testing.
- To explain the integration of advanced lipid testing into clinical decision-making for ASCVD prevention.
Main Methods:
- Utilizing 2018 cholesterol guidelines for patient selection.
- Calculating 10-year ASCVD risk scores for individuals aged 40-75.
- Incorporating risk-enhancing factors and advanced lipid tests (Apolipoprotein B, lipoprotein (a)) for personalized risk assessment.
Main Results:
- Advanced lipid testing, including Apolipoprotein B and lipoprotein (a), can refine ASCVD risk estimations.
- These tests aid in identifying genetic disorders and reclassifying risk in specific patient populations.
- Risk-enhancing factors personalize decisions for initiating statin therapy in intermediate-risk patients.
Conclusions:
- Advanced lipid testing optimizes ASCVD prevention by enhancing risk assessment.
- The decision-making cascade involves risk score calculation, personalization with enhancing factors, and risk reclassification.
- Integrating advanced lipid testing into clinical practice improves personalized cardiovascular risk management.
Abstract:
Lipid profiles help estimate patient's short- and long-term atherosclerotic cardiovascular disease risk over the life course and inform treatment decisions. Advanced lipid testing can provide additional information in selected patients. New 2018 cholesterol guidelines suggest which patients may benefit from additional testing. In patients ages 40-75 years, calculation of a 10-year atherosclerotic cardiovascular disease risk score begins the clinician-patient risk discussion. In those at intermediate risk (10-year risk 7.5%-19.9%) for future events, inclusion of enhancing factors personalizes the risk decision. The guidelines identify enhancing factors that can support initiating statin therapy. Two advanced lipid tests may be used. Apolipoprotein B levels improve risk estimations and identify genetic disorders in hypertriglyceridemic patients. In patients with a family history of premature atherosclerotic cardiovascular disease, significantly elevated lipoprotein (a) levels may reclassify risk. The decision-making cascade of estimating 10-year risk, personalizing risk status with risk-enhancing factors, and, if appropriate, reclassifying risk with a coronary artery calcium score is advanced lipid thinking that can utilize advanced lipid testing to optimize atherosclerotic cardiovascular disease prevention.
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