Assessment of Low LDL Cholesterol in Patients Treated by PCSK9 Inhibition: Comparison of Martin/Hopkins and Friedewald Estimations.
Cardiovasc Drugs Ther
; 35(4): 787-792, 2021 08.
Article
em En
| MEDLINE
| ID: mdl-33226544
ABSTRACT
PURPOSE:
Recent guidelines recommend further reduction of low-density lipoprotein cholesterol (LDL-C) in high-risk populations. The use of proprotein convertase subtilisin/kexin type-9 inhibitors (PCSK9i) enables many patients to achieve profound reduction in LDL-C. However, in patients with low cholesterol, the commonly used Friedewald equation tends to underestimate LDL-C, which may result in undertreatment. We aimed to compare Friedewald LDL-C estimation with the more novel Martin/Hopkins method in PCSK9i-treated patients achieving low LDL-C.METHODS:
We investigated high-risk patients treated by PCSK9i in whom Friedewald LDL-C levels were < 70 mg/dL and triglycerides ≤ 300 mg/dL. LDL-C was additionally assessed by the Martin/Hopkins method. The compatibility between estimations was evaluated using methods of concordance and reclassification between LDL-C categories (< 25, 25-40, 40-55, 55-70 mg/dL) and according to triglyceride strata.RESULTS:
Mean age was 65 ± 10 years. The correlation coefficient between LDL-C estimations was r = 0.898. Martin/Hopkins reclassified 269 of the 608 patients (44%) to a higher LDL-C category, with 14% of the patients reaching LDL-C > 70 mg/dL. Of the 390 patients achieving Friedewald LDL-C < 55 mg/dL, 113 (29%) were estimated to have LDL-C ≥ 55 mg/dL by the Martin/Hopkins equation. The magnitude of discordance between LDL-C estimates was more pronounced in hypertriglyceridemic patients in whom LDL-C reclassification from < 55 to ≥ 55 mg/dL was observed in 48%.CONCLUSIONS:
In real-world practice of high-risk patients achieving low LDL-C under PCSK9i, Martin/Hopkins algorithm displayed significant proportion of LDL-C upward discordance compared to the Friedewald equation, particularly observed in patients with elevated triglycerides, identifying patients that may need treatment intensification.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Dislipidemias
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Inibidores de PCSK9
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LDL-Colesterol
Tipo de estudo:
Diagnostic_studies
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Etiology_studies
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Evaluation_studies
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Guideline
/
Prognostic_studies
Limite:
Aged
/
Female
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Humans
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Male
Idioma:
En
Revista:
Cardiovasc Drugs Ther
Assunto da revista:
ANGIOLOGIA
/
CARDIOLOGIA
/
TERAPIA POR MEDICAMENTOS
Ano de publicação:
2021
Tipo de documento:
Article
País de afiliação:
Israel