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Quantifying atherogenic lipoproteins for lipid-lowering strategies: Consensus-based recommendations from EAS and EFLM

Journal article
Authors B. G. Nordestgaard
M. R. Langlois
A. Langsted
M. J. Chapman
K. M. Aakre
H. Baum
Jan Borén
E. Bruckert
A. Catapano
C. Cobbaert
P. Collinson
O. S. Descamps
C. J. Duff
A. von Eckardstein
A. Hammerer-Lercher
P. R. Kamstrup
G. Kolovou
F. Kronenberg
S. Mora
K. Pulkki
A. T. Remaley
N. Rifai
E. Ros
S. Stankovic
A. Stavljenic-Rukavina
G. Sypniewska
G. F. Watts
Olov Wiklund
P. Laitinen
Soc European Atherosclerosis
Chem European Federation Clinical
Published in Atherosclerosis
Volume 294
Pages 46-61
ISSN 0021-9150
Publication year 2020
Published at Wallenberg Laboratory
Pages 46-61
Language en
Keywords Atherosclerotic cardiovascular disease, LDL cholesterol, Remnant, cholesterol, non-HDL cholesterol, Apolipoprotein B, Lipoprotein(a), coronary-heart-disease, non-hdl cholesterol, triglyceride-rich, lipoproteins, cardiovascular risk reduction, nuclear-magnetic-resonance, apolipoprotein-b levels, division working group, ldl-cholesterol, familial hypercholesterolemia, clinical-chemistry, Cardiovascular System & Cardiology
Subject categories Clinical Medicine


The joint consensus panel of the European Atherosclerosis Society (EAS) and the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) recently addressed present and future challenges in the laboratory diagnostics of atherogenic lipoproteins. Total cholesterol, triglycerides, HDL cholesterol, LDL cholesterol, and calculated non-HDL cholesterol (= total - HDL cholesterol) constitute the primary lipid panel for estimating risk of atherosclerotic cardiovascular disease (ASCVD) and can be measured in the nonfasting state. LDL cholesterol is the primary target of lipid-lowering therapies. For on-treatment follow-up, LDL cholesterol shall be measured or calculated by the same method to attenuate errors in treatment decisions due to marked between-method variations. Lipoprotein(a)-cholesterol is part of measured or calculated LDL cholesterol and should be estimated at least once in all patients at risk of ASCVD, especially in those whose LDL cholesterol decline poorly upon statin treatment. Residual risk of ASCVD even under optimal LDL-lowering treatment should be also assessed by non-HDL cholesterol or apolipoprotein B, especially in patients with mild-to-moderate hypertriglyceridemia (2-10 mmol/L). Non-HDL cholesterol includes the assessment of remnant lipoprotein cholesterol and shall be reported in all standard lipid panels. Additional apolipoprotein B measurement can detect elevated LDL particle numbers often unidentified on the basis of LDL cholesterol alone. Reference intervals of lipids, lipoproteins, and apolipoproteins are reported for European men and women aged 20-100 years. However, laboratories shall flag abnormal lipid values with reference to therapeutic decision thresholds.

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Utskriftsdatum: 2020-08-12