A1 Journal article – refereed
Quantifying atherogenic lipoproteins: Current and future challenges in the era of personalized medicine and very low concentrations of ldl cholesterol. a consensus statement from EAS and EFLM

List of Authors: Michel R. Langlois, M. John Chapman, Christa Cobbaert, Samia Mora, Alan T. Remaley, Emilio Ros, Gerald F. Watts, Jan Borén, Hannsjörg Baum, Eric Bruckert, Alberico Catapano, Olivier S. Descamps, Arnold von Eckardstein, Pia R. Kamstrup, Genovefa Kolovou, Florian Kronenberg, Anne Langsted, Kari Pulkki, Nader Rifai, Grazyna Sypniewska, Olov Wiklund, Børge G. Nordestgaard
Publisher: American Association for Clinical Chemistry Inc.
Publication year: 2018
Journal: Clinical Chemistry
Journal name in source: Clinical Chemistry
Volume number: 64
Issue number: 7
Number of pages: 28
ISSN: 0009-9147
eISSN: 1530-8561


The European Atherosclerosis Society–European Federation of Clinical
Chemistry and Laboratory Medicine Consensus Panel aims to provide
recommendations to optimize atherogenic lipoprotein quantification for
cardiovascular risk management.

We critically examined LDL cholesterol, non-HDL cholesterol,
apolipoprotein B (apoB), and LDL particle number assays based on key
criteria for medical application of biomarkers. (a) Analytical
performance: Discordant LDL cholesterol quantification occurs when LDL
cholesterol is measured or calculated with different assays, especially
in patients with hypertriglyceridemia >175 mg/dL (2 mmol/L) and low
LDL cholesterol concentrations <70 mg/dL (1.8 mmol/L). Increased
lipoprotein(a) should be excluded in patients not achieving LDL
cholesterol goals with treatment. Non-HDL cholesterol includes the
atherogenic risk component of remnant cholesterol and can be calculated
in a standard nonfasting lipid panel without additional expense. ApoB
more accurately reflects LDL particle number. (b) Clinical
performance: LDL cholesterol, non-HDL cholesterol, and apoB are
comparable predictors of cardiovascular events in prospective population
studies and clinical trials; however, discordance analysis of the
markers improves risk prediction by adding remnant cholesterol (included
in non-HDL cholesterol) and LDL particle number (with apoB) risk
components to LDL cholesterol testing. (c) Clinical and
cost-effectiveness: There is no consistent evidence yet that non-HDL
cholesterol-, apoB-, or LDL particle-targeted treatment reduces the
number of cardiovascular events and healthcare-related costs than
treatment targeted to LDL cholesterol.

Follow-up of pre- and on-treatment (measured or calculated) LDL
cholesterol concentration in a patient should ideally be performed with
the same documented test method. Non-HDL cholesterol (or apoB) should be
the secondary treatment target in patients with mild to moderate
hypertriglyceridemia, in whom LDL cholesterol measurement or calculation
is less accurate and often less predictive of cardiovascular risk.
Laboratories should report non-HDL cholesterol in all standard lipid

Internal Authors/Editors

Last updated on 2019-09-07 at 18:01