Porovnanie vplyvu troch metód na výpočet LDL cholesterolu na kategorizáciu rizika kardiovaskulárnych ochorení v troch odlišných populáciách pacientov. (Slovak)

omparison of three methods for LDL-cholesterol calculation for cardiovascular disease risk categorisation in three distinct patient populations. (English)

Background: Limitations of the Friedewald equation for low-density lipoprotein cholesterol (F-LDLC) calculation, which is used by ≈ 33% of laboratories in Slovakia and 66% of laboratories in Europe, led to the Martin-Hopkins (M-LDLC), extended Martin-Hopkins (extM-LDLC) and Sampson/National Institutes of Health (S-LDLC) equations. We studied these newer calculations of LDLC for correlation and discordance for stratification into the 2019 ESC/EAS Guidelines’ cardiovascular disease (CVD) risk categories. Methods: We performed analyses on lipid profiles from 3 populations: 873 healthy children from the cross-sectional Slovak Lipid Community Study (population SLCS), records of a 1949 patients of a hospital biochemistry laboratory from from a specialized cardio centre (population VÚSCH), and records of 9113 patients of a hospital biochemistry laboratory from a large general hospital (population FN FDR). Patients were categorized as concordant if LDL-C was <1.8 mmol/l with each pairwise comparison of equations, and as discordant if LDL-C was <1.8 mmol/l for the index equation and ≥1.8 mmol/l for the comparator. Separate comparisons were made for subpopulations with TAG values ≥1.7 mmol/l. Results: There was very strong correlation among the 3 calculated LDLC in all 3 populations. The extM-LDLC equation consistently estimated higher LDL-C values than the Friedewald and Sampson equations. Discordance rates for for the F-LDLC vs extM-LDLC for population SLCS were 0.9% and 3.7% for subpopulation with TAG values ≥1.7 mmol/l, respectively. Discordance rates for for the F-LDLC vs extM-LDLC for population VÚSCH were 3.4% and 8.9% for subpopulation with TAG values ≥1.7 mmol/l, respectively. Discordance rates for for the F-LDLC vs extMLDLC for population FN FDR were 4.1% and 8.2% for subpopulation with TAG values ≥1.7 mmol/l, respectively. Conclusions: Switching from F-LDLC to extM-LDLC or S-LDLC can reclassify up to ≈ 3.4% or 8.9% of patients, respectively, to a higher CVD risk category. The difference between F-LDLC and extM-LDLC or S-LDLC is greater with higher TG, and with lower LDLC. Reliance on the Friedewald equation may result in the underestimation and undertreatment of LDL-C in those at increased risk. We recommend, in line with some national/international guidelines, that clinical laboratories switch to counting and reporting results to extM-LDLC. [ABSTRACT FROM AUTHOR]

Východiská: Obmedzenia Friedewaldovej rovnice na výpočet cholesterolu v lipoproteínoch s nízkou hustotou (F-LDLC), ktorú používa približne 33 % laboratórií na Slovensku a 66 % laboratórií v Európe, viedli ku vytvoreniu nových rovníc Martin-Hopkins (M-LDLC), rozšírený Martin-Hopkins (extM-LDLC) a Sampson/NIH (S-LDLC). Študovali sme tieto novšie výpočty LDLC na koreláciu a zhodu či nezhodu pre stratifikáciu do rizikových kategórií srdcovocievnych ochorení (SCCH) podľa guidelinu ESC/EAS z roku 2019. Metódy: Vykonali sme analýzy lipidových profilov z troch populácií: 873 zdravých detí z prierezovej štúdie Slovak Lipid Community Study (populácia SLCS), záznamy 1 949 pacientov nemocničného biochemického laboratória zo špecializovaného kardiocentra (populácia VÚSCH), a záznamy 9 113 pacientov nemocničného biochemického laboratória z fakultnej nemocnice (populácia FN FDR). Pacienti boli kategorizovaní ako zhodní, ak LDL-C bol < 1,8 mmol/l pri každom párovom porovnaní rovníc, a ako nezhodní, ak LDL-C bol < 1,8 mmol/l pre indexovú rovnicu a ≥ 1,8 mmol/l pre porovnávanú rovnicu. Samostatné porovnania boli vykonané pre subpopulácie s hodnotami TAG ≥ 1,7 mmol/l. Výsledky: Medzi tromi vypočítanými LDLC bola vo všetkých troch populáciách veľmi silná korelácia. Rovnica extM-LDLC v celom priebehu hodnôt odhadovala vyššie hodnoty LDL-C ako Friedewaldova a Sampsonova rovnica. Miery nesúladu pre F-LDLC vs extM-LDLC pre populáciu SLCS boli 0,9 % a 3,7 % pre subpopuláciu s hodnotami TAG ≥ 1,7 mmol/l. Miery nesúladu pre F-LDLC vs extM-LDLC pre populáciu VÚSCH boli 3,4 % a 8,9 % pre subpopuláciu s hodnotami TAG ≥ 1,7 mmol/l. Miera nesúladu pre F-LDLC vs. extMLDLC pre populačnú FN FDR bola 4,1 % a 8,2 % pre subpopuláciu s hodnotami TAG ≥ 1,7 mmol/l. Závery: Prechod z F-LDLC na extM-LDLC alebo S-LDLC môže reklasifikovať až od 3,4 % do 8,9 % pacientov do vyššej kategórie rizika KVO. Rozdiel medzi F-LDLC a extM-LDLC alebo S-LDLC je väčší pri vyššej TG a pri nižšej LDLC. Používanie Friedewaldovej rovnice môže viesť k podhodnoteniu a nedostatočnej liečbe LDL-C u pacientov so zvýšeným rizikom. Odporúčame, v súlade s niektorými národnými/medzinárodnými smernicami, aby klinické laboratóriá prešli na počítanie a hlásenie výsledkov do extM-LDLC. [ABSTRACT FROM AUTHOR]

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