Lipid measurements in the management of cardiovascular diseases: Practical recommendations a scientific statement from the national lipid association writing group

• Published in: Journal of clinical lipidology 2021-09, Vol.15 (5), p.629-648
• Main Authors: Wilson, Peter W.F., Jacobson, Terry A., Martin, Seth S., Jackson, Elizabeth J., Le, N-Anh, Davidson, Michael H., Vesper, Hubert W., Frikke-Schmidt, Ruth, Ballantyne, Christie M., Remaley, Alan T.
• Format: Article
• Language: English
• Subjects: Apolipoprotein B; Atherosclerotic cardiovascular disease; Biomarkers; Biomarkers - blood; Cholesterol, HDL - blood; Cholesterol, LDL - blood; Coronary Artery Disease - diagnosis; Coronary Artery Disease - prevention & control; Female; HDL cholesterol; Heart Disease Risk Factors; Humans; Hypercholesterolemia - diagnosis; Laboratory; LDL cholesterol; Lipid Metabolism Disorders; Male; Non-HDL cholesterol; Practice Guidelines as Topic; Scientific statement; Societies, Medical - organization & administration
• ISSN: 1933-2874; 1876-4789
• DOI: 10.1016/j.jacl.2021.09.046

•It is acceptable to screen with nonfasting lipids.•It is recommended to follow up abnormal results with fasting levels.•Non-HDL cholesterol levels can effectively guide ASCVD prevention.•Advanced lipoprotein tests may guide therapeutic decisions in select patients.•Better harmonization of advanced lipid measurement methods is needed.•Recommendations for lipids in clinical care. Lipoprotein measurements are pivotal in the management of patients at risk for atherosclerotic coronary heart disease (CHD) with myocardial infarction and coronary death as the main outcomes, and for atherosclerotic cardiovascular disease (ASCVD), which includes CHD and stroke. Recent developments and changes in guidelines affect optimization of using lipid measures as cardiovascular biomarkers. This scientific statement reviews the pre-analytical, analytical, post-analytical, and clinical aspects of lipoprotein measurements. Highlights include the following: i) It is acceptable to screen with nonfasting lipids. ii) non-high-density lipoprotein HDL-cholesterol (non-HDL-C) is measured reliably in either the fasting or the nonfasting state and can effectively guide ASCVD prevention. iii) low density lipoprotein cholesterol (LDL-C) can be estimated from total cholesterol, high density lipoprotein cholesterol (HDL-C), and triglyceride (TG) measurements. For patients with LDL-C>100 mg/dL and TG ≤150 mg/dL it is reasonable to use the Friedewald formula. However, for those with TG 150-400 mg/dL the Friedewald formula for LDL-C estimation is less accurate. The Martin/Hopkins method is recommended for LDL-C estimation throughout the range of LDL-C levels and up to TG levels of 399 mg/dL. For TG levels ≥400 mg/dL LDL-C estimating equations are currently not recommended and newer methods are being evaluated. iv) When LDL-C or TG screening results are abnormal the clinician should consider obtaining fasting lipids. v) Advanced lipoprotein tests using apolipoprotein B (apoB), LDL Particle Number (LDL-P) or remnant cholesterol may help to guide therapeutic decisions in select patients, but data are limited for patients already on lipid lowering therapy with low LDL-C levels. Better harmonization of advanced lipid measurement methods is needed. Lipid measurements are recommended 4-12 weeks after a change in lipid treatment. Lipid laboratory reports should denote desirable values and specifically identify extremely elevated LDL-C levels (≥190 mg/dL at any age or ≥160 mg/dL in children) as severe h