Resumen

Comparing treatment targets in familial combined hyperlipidemia

Comparación de los objetivos terapéuticos en la hiperlipidemia familiar combinada

VOLUMEN 2 - NÚMERO 3 / Julio - Septiembre (Artículos originales / Original articles)

Roopa Mehta, Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ); Universidad Nacional Autónoma de México, México City, México
Enrique Reyes-Rodríguez, Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), México, D.F., México
Ana Carmen Guerrero-Diaz, Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), México, D.F., México
Ivette Cruz-Bautista, Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), México, D.F., México
Carlos A. Aguilar-Salinas, Direction of Nutrition, Instituto Nacional del Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico

Introduction: Low-density lipoprotein cholesterol remains the principle goal of lipid-lowering therapy. Estimating low-density lipoprotein cholesterol using the Friedewald equation is unreliable when triglycerides are > 400 mg/dl. Furthermore, there is often a mismatch between the concentration of low-density lipoprotein cholesterol and the number of atherogenic particles. Consequently, non-high-density lipoprotein cholesterol (concentration of cholesterol in atherogenic particles) and apolipoprotein B (number of atherogenic particles) are considered alternative targets. This study evaluated the correlation and concordance of low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, and apolipoprotein B in persons with familial combined hyperlipidemia. Methods: A cross-sectional study including 410 familial combined hyperlipidemia subjects. A complete lipid profile was obtained for each participant: total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, apolipoprotein B, and non-high-density lipoprotein cholesterol. The concordance (kappa) and correlation (rho) between low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, and apolipoprotein B was calculated. Results: The correlation coefficients for low-density lipoprotein cholesterol with non-high-density lipoprotein cholesterol and apolipoprotein B were low (0.41 and 0.50, respectively; p = 0.000). With low-density lipoprotein cholesterol < 100 mg/dl, 61.7 and 73.9% exceeded the non-high-density lipoprotein cholesterol and apolipoprotein B goals, respectively. The concordance (kappa) between low-density lipoprotein cholesterol target and non-high-density lipoprotein cholesterol and apolipoprotein B targets was 0.253 and 0.165, respectively (p = 0.000). In subjects with triglycerides < 400 mg/dl, non-high-density lipoprotein cholesterol < 130 mg/dl showed a stronger agreement with low-density lipoprotein cholesterol < 100 mg/dl than apolipoprotein B < 90 mg/dl (k = 0.40 vs. k = 0.26). In the first triglyceride tertile (triglycerides < 192 mg/dl), the concordance between low-density lipoprotein cholesterol < 100 mg/dl and non-high-density lipoprotein cholesterol < 130 mg/dl was 0.94, and with apolipoprotein B < 90 mg/dl it was 0.51 (p = 0.000). Conclusions: In familial combined hyperlipidemia, the concordance among lipid targets is low. In these subjects a more informative lipid assessment that includes low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, and apolipoprotein B, is needed.

Palabras clave: Lipids. FCHL. Treatment targets.