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Risk determination of dyslipidemia in populations characterized by low levels of high-density lipoprotein cholesterol.

Abstract

BACKGROUND

Current guidelines for managing dyslipidemia qualify patients for treatment based on low-density lipoprotein cholesterol (LDL-C) levels and other risk factors for coronary heart disease (CHD). However, when LDL-C is the sole lipid criterion for initiating therapy, patients with levels below the treatment initiation threshold who are at high risk because of low levels (<40 mg/dL) of high-density lipoprotein cholesterol (HDL-C) might not be identified. Twenty percent of male patients with CHD in the United States fall into this category. The total cholesterol/HDL-C (TC/HDL-C) ratio predicts CHD risk regardless of the absolute LDL-C and HDL-C.

METHODS

We compared guidelines based on TC/HDL-C and LDL-C with those recommended by the National Cholesterol Education Program Adult Treatment Panel III (ATP III). Both sets of guidelines were applied to 9837 adults (>20 years of age) in the Turkish Heart Study, which has shown that 75% of men and 50% of women in Turkey have HDL-C <40 mg/dL.

RESULTS

ATP III guidelines identified 14% of Turkish adults, 20 years or older, as candidates for lifestyle treatment only and an additional 18% for drug treatment. In conjunction with ATP III LDL-C thresholds, the TC/HDL-C ratio (>3.5, patients with CHD; > or =6.0, 2+ risk factors, > or =7.0, 0 to 1 risk factor) assigned lifestyle therapy alone to 18% and drug treatment to an additional 36%. Among primary prevention subjects at high risk because of age (men > or =45 years; women > or =55 years), both sets of guidelines prescribed lifestyle therapy for only 5%; however, drug treatment was recommended for an additional 13% by ATP III guidelines and an additional 18% by TC/HDL-C and LDL-C.

CONCLUSIONS

In populations at risk for CHD caused by low HDL-C, qualification of subjects for treatment based on either the TC/HDL-C ratio or LDL-C thresholds identifies more high-risk subjects for treatment than LDL-C threshold values alone, and use of the ratio, instead of risk tables, simplifies the approach for physicians.

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  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Gladstone Institute, American Hospital, Istanbul, Turkey. tbersot@gladstone.ucsf.edu

    ,

    Source

    American heart journal 146:6 2003 Dec pg 1052-9

    MeSH

    Adult
    Age Factors
    Body Mass Index
    Cholesterol, HDL
    Cholesterol, LDL
    Cohort Studies
    Coronary Disease
    Female
    Humans
    Hyperlipidemias
    Male
    Practice Guidelines as Topic
    Risk Factors
    Sex Factors
    Triglycerides
    Turkey

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    14660998

    Citation

    Bersot, Thomas P., et al. "Risk Determination of Dyslipidemia in Populations Characterized By Low Levels of High-density Lipoprotein Cholesterol." American Heart Journal, vol. 146, no. 6, 2003, pp. 1052-9.
    Bersot TP, Pépin GM, Mahley RW. Risk determination of dyslipidemia in populations characterized by low levels of high-density lipoprotein cholesterol. Am Heart J. 2003;146(6):1052-9.
    Bersot, T. P., Pépin, G. M., & Mahley, R. W. (2003). Risk determination of dyslipidemia in populations characterized by low levels of high-density lipoprotein cholesterol. American Heart Journal, 146(6), pp. 1052-9.
    Bersot TP, Pépin GM, Mahley RW. Risk Determination of Dyslipidemia in Populations Characterized By Low Levels of High-density Lipoprotein Cholesterol. Am Heart J. 2003;146(6):1052-9. PubMed PMID: 14660998.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Risk determination of dyslipidemia in populations characterized by low levels of high-density lipoprotein cholesterol. AU - Bersot,Thomas P, AU - Pépin,Guy M, AU - Mahley,Robert W, PY - 2003/12/9/pubmed PY - 2004/1/14/medline PY - 2003/12/9/entrez SP - 1052 EP - 9 JF - American heart journal JO - Am. Heart J. VL - 146 IS - 6 N2 - BACKGROUND: Current guidelines for managing dyslipidemia qualify patients for treatment based on low-density lipoprotein cholesterol (LDL-C) levels and other risk factors for coronary heart disease (CHD). However, when LDL-C is the sole lipid criterion for initiating therapy, patients with levels below the treatment initiation threshold who are at high risk because of low levels (<40 mg/dL) of high-density lipoprotein cholesterol (HDL-C) might not be identified. Twenty percent of male patients with CHD in the United States fall into this category. The total cholesterol/HDL-C (TC/HDL-C) ratio predicts CHD risk regardless of the absolute LDL-C and HDL-C. METHODS: We compared guidelines based on TC/HDL-C and LDL-C with those recommended by the National Cholesterol Education Program Adult Treatment Panel III (ATP III). Both sets of guidelines were applied to 9837 adults (>20 years of age) in the Turkish Heart Study, which has shown that 75% of men and 50% of women in Turkey have HDL-C <40 mg/dL. RESULTS: ATP III guidelines identified 14% of Turkish adults, 20 years or older, as candidates for lifestyle treatment only and an additional 18% for drug treatment. In conjunction with ATP III LDL-C thresholds, the TC/HDL-C ratio (>3.5, patients with CHD; > or =6.0, 2+ risk factors, > or =7.0, 0 to 1 risk factor) assigned lifestyle therapy alone to 18% and drug treatment to an additional 36%. Among primary prevention subjects at high risk because of age (men > or =45 years; women > or =55 years), both sets of guidelines prescribed lifestyle therapy for only 5%; however, drug treatment was recommended for an additional 13% by ATP III guidelines and an additional 18% by TC/HDL-C and LDL-C. CONCLUSIONS: In populations at risk for CHD caused by low HDL-C, qualification of subjects for treatment based on either the TC/HDL-C ratio or LDL-C thresholds identifies more high-risk subjects for treatment than LDL-C threshold values alone, and use of the ratio, instead of risk tables, simplifies the approach for physicians. SN - 1097-6744 UR - https://www.unboundmedicine.com/medline/citation/14660998/Risk_determination_of_dyslipidemia_in_populations_characterized_by_low_levels_of_high_density_lipoprotein_cholesterol_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002870303005167 DB - PRIME DP - Unbound Medicine ER -