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Overlapping Pattern of the Four Individual Components of Dyslipidemia in Adults: Analysis of Nationally
Wenxiao Zheng1, Jiayue Zhang2, Ying Jiang3
1JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China.
Insights
Many with dyslipidemia have high triglycerides or low HDL cholesterol but normal LDL-C and TC. These individuals may not benefit from current lipid-lowering drugs, necessitating alternative interventions for effective cardiovascular disease prevention.
Area of Science:
- Cardiovascular Disease Research
- Lipid Metabolism Studies
- Public Health and Epidemiology
Background:
- Dyslipidemia is a significant risk factor for cardiovascular disease (CVD).
- Current lipid-lowering drugs primarily benefit those with high LDL-C or TC, with limited efficacy for isolated high TG or low HDL-C.
- Understanding dyslipidemia patterns is crucial for precise drug utilization and identifying populations less responsive to existing treatments.
Purpose of the Study:
- To investigate the overlapping patterns of four key dyslipidemia components (high TC, high LDL-C, high TG, low HDL-C) in the US adult population.
- To quantify the proportion of individuals with dyslipidemia who may not benefit from current lipid-lowering therapies.
- To inform the development of more targeted and cost-effective dyslipidemia management strategies.
Main Methods:
- Analysis of data from 7822 US adults with dyslipidemia from NHANES (1999-2018), excluding those on lipid-lowering medication.
- Calculation and visualization of the prevalence of various combinations of dyslipidemia components using area-proportional Euler plots.
- Stratification of dyslipidemia cases based on specific lipid profiles, including isolated low HDL-C and high TG with normal LDL-C/TC.
Main Results:
- High TC, high LDL-C, high TG, and low HDL-C were prevalent in 32.8%, 28.1%, 26.7%, and 65.9% of dyslipidemic participants, respectively.
- Dyslipidemia driven by high LDL-C or high TC affected 37.5% of cases.
- A significant proportion, 18.3% and 44.2%, had high TG or isolated low HDL-C, respectively, with normal LDL-C and TC.
Conclusions:
- Approximately two-thirds of individuals with dyslipidemia present with high TG or low HDL-C alongside normal LDL-C and TC levels.
- These individuals are less likely to experience CVD prevention benefits from current standard lipid-lowering drug treatments.
- There is a critical need for novel interventions and strategies to effectively manage dyslipidemia in these specific patient groups for improved cardiovascular outcomes.
Abstract:
Background/Objectives: Dyslipidemia is a well-established risk factor for cardiovascular disease (CVD). However, among available drug treatments, only those targeted at lowering LDL-C and consequently TC have demonstrated efficacy in preventing CVD. This is to say that the benefit for those with isolated high TG or low HDL-C is limited. The objective of this study is to examine the overlapping pattern of the four dyslipidemia components in US adult populations, which is important for quantifying the proportion of those who are less likely to benefit from lipid-lowering drugs and for a more precise use of the drug. Methods: A total of 7822 participants aged over 20 with abnormalities in any of the four lipid parameters, excluding those on lipid-lowering medications, were included from the National Health and Nutrition Examination Survey (NHANES) cycles spanning 1999-2000 through 2017-2018. The proportions of different combinations of them were calculated and presented using area-proportional Euler plots. Results: High TC, high LDL-C, high TG, and low HDL-C were seen in 32.8% (95% CI: 31.3%-34.2%), 28.1% (95% CI: 26.6%-29.6%), 26.7% (95% CI: 25.4%-28.0%), and 65.9% (95% CI: 64.0%-67.7%) of the people with dyslipidemia, respectively. The proportions of dyslipidemia cases attributable to "high LDL-C or high TC" (irrespective of HDL-C and TG levels), "normal LDL-C, normal TC, but high TG" (irrespective of HDL-C level), and "normal LDL-C, normal TC, normal TG, but low HDL-C" (i.e., isolated low HDL-C) accounted for 37.5% (95% CI: 35.9%-39.1%), 18.3% (95% CI: 17.2%-19.4%), and 44.2% (95% CI: 42.5%-46.0%), respectively. Conclusions: Some two-thirds of those with dyslipidemia had low HDL-C or high TG but normal LDL-C and normal TC. As these people are less likely to benefit from currently available drug treatments in terms of CVD prevention, it is important to identify other effective strategies or interventions targeted at them in order to achieve more precise and cost-effective management of dyslipidemia.
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