Application and validation of a diagnostic algorithm for the atherogenic apoB dyslipoproteinemias

作者：Holewijn Suzanne^*; Sniderman Allan D; den Heijer Martin; Swinkels Dorine W; Stalenhoef Anton F H; de Graaf Jacqueline

来源：European Journal of Clinical Investigation, 2011, 41(4): 423-433.

DOI：10.1111/j.1365-2362.2010.02426.x

• Atherosclerosis
• cardiovascular risk
• lipoproteins
• noninvasive
• population-based
• ultrasound

P>Background
We applied a diagnostic algorithm using apolipoprotein B (apoB) in combination with triglycerides (TG) and total cholesterol to determine the prevalence of dyslipoproteinemias in the general population. We also characterized the overall cardiovascular (CV) risk profiles, including arterial structure and function as measured with a panel of noninvasive parameters.
Design
Clinical and biochemical characteristics and noninvasive measurements of atherosclerosis (NIMA) were determined in 1517 individuals, aged 50-70 years.
Results
In general, all dyslipoproteinemias were characterized by a worse CV risk profile and deteriorated outcomes of NIMA compared to those with normal apolipoprotein B (< 1 center dot 2 g L-1) and TG (< 1 center dot 5 mM) levels. The prevalence of hyperapoB-hyperTG was 15 center dot 1%, and these individuals showed the most abnormal atheroma-related parameters: reduced ankle-brachial-index at rest (-3 center dot 5%) and after exercise (-9 center dot 8%), increased intima-media thickness (+5 center dot 5%) and more carotid plaques (+39 center dot 1%). The prevalence of normoapoB-hyperTG because of increased VLDL was 18 center dot 1% and 2 center dot 3% because of increased chylomicrons and VLDL, and in these groups, the parameters related to stiffness (e.g. pulse-wave-velocity +7 center dot 6% and +5 center dot 2%, respectively) were most abnormal. Adjustment for apolipoprotein B (apoB) reduced differences in NIMA in the hyperapoB-hyperTG group, whereas adjustment for TG reduced differences in NIMA in the normoapoB-hyperTG group.
Conclusions
The overall prevalence of dyslipoproteinemias according to the algorithm was approximately 40% in the Dutch population. The different dyslipoproteinemias showed a less favourable CV risk profile and deteriorated NIMA parameters, reflecting increased subclinical atherosclerosis. Furthermore, different effects on different NIMA parameters were observed in the different dyslipoproteinemias.

• 出版日期2011-4