小型低密度リポプロテイン-コレステロールの評価が,選択された世界レベルの脱脂症指針における二次性非高密度リポプロテイン-Cおよびアポリポプロテイン-Bの有用性への影響
Vasanth Sathiyakumar1, Jihwan Park2, Renato Quispe1
1Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD (V.S., R.Q., E.D.M., P.P.T., S.P.W., R.S.B., S.R.J., S.S.M.).
Circulation
|March 7, 2018
まとめ
低密度リポプロテイン・コレステロール (LDL- C) の正確な推定では,高密度リポプロテイン・コレステロール (non- HDL- C) とアポリポプロテインB (apoB) の標的は,稀に脱脂症の管理を変化させる. 現在のapoB目標は,LDL-Cとnon-HDL-Cの目標を達成した後に限られた付加価値を提供する.
科学分野:
- 心血管医学
- 脂質学
- 予防的な心臓科
背景:
- 脱脂症のガイドラインは,非HDL-CとapoBを,LDL-Cの二次標的として使用しています.
- LDL-Cの推定方法の正確さは,治療決定に影響を与える可能性があります.
研究 の 目的:
- 2つのLDL-C推定方法を用いて,非HDL-C標的の管理の変更頻度を評価する.
- LDL-Cとnon-HDL-Cの目標が達成された後のapoBの有用性を評価する.
主な方法:
- 米国の人口データ (NHANES) と大規模な脂質データベース (VLdL) の分析.
- フリーデワルド (LDL-CF) と新しい正確な方法 (LDL-CN) を用いたLDL-C推定値の比較
- 高リスクグループを含む,LDL-C,non-HDL-C,およびapoBガイドラインのターゲットを満たしている個人の評価.
主要な成果:
- LDL-CNを使用すると,非HDL-CまたはapoBのターゲットを超えたのは約1〜2%の個人で,LDL-CFとは対照的に,8〜38%が達成しました.
- 高リスクの個体では,LDL-CNは,非HDL-CおよびapoBのターゲットと最小の差異を示した (~0~3%).
- 二重のLDL-Cと非HDL-Cの目標を達成することは,非常に少数の個人がapoBの目標 (0-1%) を超えたことを意味しました.
結論:
- より正確なLDL-Cの推定では,HDL-C以外の標的は管理に限られた影響を及ぼします.
- コレステロールの目標を達成すると,現在のapoB目標はわずかな追加利益をもたらします.
- 結果は,様々な患者集団と治療状態に一致しています.
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