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

Journal article
Authors M. R. Langlois
Bø G. Nordestgaard
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
Published in Clinical Chemistry and Laboratory Medicine
Volume 58
Issue 4
Pages 496-517
ISSN 1434-6621
Publication year 2020
Published at Wallenberg Laboratory
Institute of Medicine
Pages 496-517
Language en
Links dx.doi.org/10.1515/cclm-2019-1253
Keywords apolipoprotein B, atherosclerotic cardiovascular disease, LDL cholesterol, lipoprotein(a), non-HDL cholesterol, remnant cholesterol
Subject categories Cardiovascular medicine

Abstract

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 (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDLC), LDL cholesterol (LDLC), and calculated non-HDLC (=total - HDLC) constitute the primary lipid panel for estimating risk of atherosclerotic cardiovascular disease (ASCVD) and can be measured in the nonfasting state. LDLC is the primary target of lipid-lowering therapies. For on-treatment follow-up, LDLC shall be measured or calculated by the same method to attenuate errors in treatment decisions due to marked between-method variations. Lipoprotein(a) [Lp(a)]-cholesterol is part of measured or calculated LDLC and should be estimated at least once in all patients at risk of ASCVD, especially in those whose LDLC declines poorly upon statin treatment. Residual risk of ASCVD even under optimal LDL-lowering treatment should be also assessed by non-HDLC or apolipoprotein B (apoB), especially in patients with mild-to-moderate hypertriglyceridemia (2-10 mmol/L). Non-HDLC includes the assessment of remnant lipoprotein cholesterol and shall be reported in all standard lipid panels. Additional apoB measurement can detect elevated LDL particle (LDLP) numbers often unidentified on the basis of LDLC 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. © 2019 Walter de Gruyter GmbH, Berlin/Boston 2019.

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