Assessing the Accuracy of Estimated Lipoprotein(a) Cholesterol and Lipoprotein(a)-Free Low-Density Lipoprotein Cholesterol.
Assessing the Accuracy of Estimated Lipoprotein(a) Cholesterol and Lipoprotein(a)-Free Low-Density Lipoprotein Cholesterol.
复制标题
评估估计脂蛋白（a）胆固醇和脂蛋白（a）-游离低密度脂蛋白胆固醇的准确性。
DOI：
10.1161/jaha.121.023136
复制
发表时间：
2022-01-18
影响因子：
5.4
通讯作者：
Martin, Seth S.
中科院分区：
文献类型：
--
作者：
Zheng, Weili;Chilazi, Michael;Park, Jihwan;Sathiyakumar, Vasanth;Donato, Leslie J.;Meeusen, Jeffrey W.;Lazo, Mariana;Guallar, Eliseo;Kulkarni, Krishnaji R.;Jaffe, Allan S.;Santos, Raul D.;Toth, Peter P.;Jones, Steven R.;Martin, Seth S.
关键词：
准确测量脂蛋白(A)(Lp[a]-C)中的胆固醇及其对低密度脂蛋白胆固醇(LDL-C)的贡献对于动脉粥样硬化性心血管疾病以及家族性高胆固醇血症的风险评估、诊断和治疗具有重要意义。提出了一种使用固定换算因子从粒子数估计Lp(A)-C的方法(对于Lp(A)质量，从粒子数除以2.4得到Lp[a]-C，对于Lp[a]-C乘以30%)。这种理论上可以分离出“不含脂蛋白(A)的低密度脂蛋白-C”的方法的准确性尚未得到验证。在来自VLDbL(超大型血脂数据库)的177名875名患者中，我们将估计的Lp(A)-C和不含Lp(A)的低密度脂蛋白-C与实测值进行了比较，并量化了绝对误差和百分比误差。我们将研究结果与梅奥临床实验室的类似数据集进行了比较。Lp(A)-C值越高，估计的Lp(A)-C和不含Lp(A)的低密度脂蛋白-C的误差越大。估计的Lp(A)-C<；10 mg/dL的中位数误差为−1.9 mg/dL(四分位数范围，−4.0至0.2)；这一误差呈线性增加，高估了Lp(A)-C≥50 mg/dL的+30.8 mg/dL(四分位数范围，26.1-36.5)。按总体高密度脂蛋白胆固醇和高密度脂蛋白胆固醇亚型分层后，这种错误关系仍然存在。在梅奥队列中也观察到了类似的发现。不含Lp(A)的Lp(A)-C的绝对误差为+2.4(四分位数范围，−0.6~5.3)，Lp(A)-C≥5 0 mg/dL的绝对误差为31.8 mg/dL(四分位数范围，Lp(A)-C≥5 0 mg/dL)。使用固定换算因子的Lp(A)-C估计高估了Lp(A)-C，随后低估了不含Lp(A)的低密度脂蛋白-C，特别是在临床相关的Lp(A)值。应用不准确的Lp(A)-C估计来校正低密度脂蛋白-C可能会导致高危患者治疗不足。
Accurate measurement of the cholesterol within lipoprotein(a) (Lp[a]‐C) and its contribution to low‐density lipoprotein cholesterol (LDL‐C) has important implications for risk assessment, diagnosis, and treatment of atherosclerotic cardiovascular disease, as well as in familial hypercholesterolemia. A method for estimating Lp(a)‐C from particle number using fixed conversion factors has been proposed (Lp[a]‐C from particle number divided by 2.4 for Lp(a) mass, multiplied by 30% for Lp[a]‐C). The accuracy of this method, which theoretically can isolate “Lp(a)‐free LDL‐C,” has not been validated. In 177 875 patients from the VLDbL (Very Large Database of Lipids), we compared estimated Lp(a)‐C and Lp(a)‐free LDL‐C with measured values and quantified absolute and percent error. We compared findings with an analogous data set from the Mayo Clinic Laboratory. Error in estimated Lp(a)‐C and Lp(a)‐free LDL‐C increased with higher Lp(a)‐C values. Median error for estimated Lp(a)‐C <10 mg/dL was −1.9 mg/dL (interquartile range, −4.0 to 0.2); this error increased linearly, overestimating by +30.8 mg/dL (interquartile range, 26.1–36.5) for estimated Lp(a)‐C ≥50 mg/dL. This error relationship persisted after stratification by overall high‐density lipoprotein cholesterol and high‐density lipoprotein cholesterol subtypes. Similar findings were observed in the Mayo cohort. Absolute error for Lp(a)‐free LDL‐C was +2.4 (interquartile range, −0.6 to 5.3) for Lp(a)‐C<10 mg/dL and −31.8 (interquartile range, −37.8 to −26.5) mg/dL for Lp(a)‐C≥50 mg/dL. Lp(a)‐C estimations using fixed conversion factors overestimated Lp(a)‐C and subsequently underestimated Lp(a)‐free LDL‐C, especially at clinically relevant Lp(a) values. Application of inaccurate Lp(a)‐C estimations to correct LDL‐C may lead to undertreatment of high‐risk patients.