Potential Effect of an Apoprotein B-based Algorithm on Management of New Patients with Hypertriglyceridemia Referred to a Specialty Lipid Clinic

Abstract

Background In patients with hypertriglyceridemia, non-high density lipoprotein cholesterol (nonHDL-C) is a targeted goal. However, apoprotein B100 (apoB) may be superior in predicting cardiovascular risk so we assessed the utility of an apoB-based. Methods New patients (n = 125) who had both apoB and standard lipids measured on the same day were included and we determined the concordances of having achieved goal lipid levels based upon proposed apoB versus nonHDL-C (ATP III) targets in patients with elevated TG (≥150 mg·dl −1 ) levels. Results Although apoB was correlated with nonHDL-C (r = 0.47, p ≤ 0.001), the tests had only a fair level of agreement when categorizing the percentage of patients achieving lipid goals for their degree of cardiovascular risk (Κ = 0.22). Among patients with an elevation in nonHDL-C above ATP III goals, between 12–42% had achieved target apoB. On the contrary, between 44–50% of patients were found to be at nonHDL-C but not apoB target. The results were not substantively altered if the analyses were confined to patients with TG values between 200–499 mg·dl −1 , rather than all patients with TG levels ≥ 150 mg·dl −1 , as specifically outlined in ATP III guidelines. In total, > 50% of all subjects would have been treated either more or less aggressively following an apoB-based therapeutic algorithm. Conclusions Our findings confirm that the majority of patients referred with hypertriglyceridemia would be managed differently by following an apoB-based treatment algorithm compared to ATP III guidelines. Although many patients would be candidates for more intense therapy, many would be treated less aggressively. Copyright © 2009 Wiley Periodicals, Inc.