NLA publishes new recommendations on lipid measurement in the management of CVD
September 24, 2021
3 minutes to read
Source / Disclosures
Wilson PWF. Session II: Fresh from the Press: Scientific Statements from the NLA. Presented at: National Lipid Association Scientific Sessions; Sep 24-26, 2021; Orlando, Florida (hybrid reunion).
Disclosures: Wilson does not report any relevant financial disclosure.
Accurate and precise measurements of lipids in the laboratory are important. As such, the National Lipid Association has released a new scientific statement on lipid measurements in the management of CVD.
The recommendations were highlighted during a presentation at the NLA Scientific Sessions and also published in the Journal of Clinical Lipidology.
Chairman of the Editorial Board Peter WF Wilson, MD, FNLA, professor of medicine in the division of cardiology at Emory University and director of epidemiology and genomic medicine at the Atlanta VA Medical Center, discussed the recommendations and emphasized how precise, accurate lipid lab reports and detailed include fasting status, desirable values, and alert values. are invaluable in guiding CV care.
Peter WF Wilson
“Most of these recommendations are known to lipidologists,” Wilson said. “In stable patients, the initial screening is fine, but when we look at the evidence, it doesn’t really say what you do after that if something is abnormal.”
According to the statement, clinicians should collect samples from ambulatory patients in a stable metabolic state. For initial screening, non-fasting lipids are acceptable. If fasting or non-fasting triglycerides are greater than 175 mg / dL, a fasting lipid monitoring measurement is recommended, according to Wilson.
“For post-analytical issues, we should really be relying on reports from our hospital systems or local groups to know what the desirable values are and what the extremes are,” Wilson said. “What are the targets for people with familial hypercholesterolemia?” We don’t usually have this on any of our reports and it’s just additional text that could be inserted into the reports. “
Lipid lab reports are more informative when desirable values are noted, depending on the presentation.
Extremely high LDL cholesterol, defined as 190 mg / dL or more at any age or 160 mg / dL or more for children, should be reported in lipid reports as severe hypercholesterolemia, due to the possibility of familial hypercholesterolemia, high Lp (a) or the need to lower LDL with high intensity statins, depending on the presentation.
Likewise, triglyceride levels above 500 mg / dL should be noted as severe hypertriglyceridemia.
Wilson pointed out other key points about measuring lipids. Lipid readings should be obtained 4 to 12 weeks after a change in lipid therapy. Wilson added that while lipid levels in critically ill patients may be lower, they shouldn’t be ignored entirely, as they aid in the later decision-making process.
Hospital lipid test results may require outpatient follow-up testing, depending on the presentation.
“LDL can be measured by Friedewald’s equation, and now there is also the [Martin/Hopkins] and the Sampson approaches. Plus, non-HDL is a fabulous dosage. Several of the committee members, and the NLA in general, have been strong supporters of the use of non-HDL, and we echo that in this report, ”Wilson said. “In general, advanced tests have very little use most of the time for initial screening and they have limited usefulness for patients on treatment.”
According to the authors, Friedewald’s equation is correct for most patients with LDL levels of 100 mg / dL or more and triglycerides less than 150 mg / dL; this equation is less precise with LDL levels below 100 mg / dL and triglycerides of 150 to 400 mg / dL. The Martin / Hopkins equation is preferred, according to the authors, especially for patients with LDL levels below 100 mg / dL and triglycerides of 150 to 400 mg / dL. Currently, estimating equations are not recommended at higher triglyceride levels (> 400 mg / dL) due to greater imprecision in the LDL estimate, depending on the presentation.
“When you sit down and start sorting out everything that goes with the Friedewald vs. Martin / Hopkins equations, the Martin / Hopkins [equation] does very well, but there are times when the Friedewald equation works particularly well, especially for higher LDL cholesterol, ”Wilson said. “There was very little low LDL cholesterol in Friedewald’s original article, and that’s part of what the Martin / Hopkins method sought: more detail and with newer technology to assess LDL. Likewise, the Sampson equation will likely be very competitive with Martin / Hopkins as this equation is adjusted over the next several years. “
In other recommendations, advanced lipoprotein tests that use apolipoprotein B, LDL particle number, and / or residual cholesterol may help guide treatment in some patients. However, data on these tests are limited for patients on lipid-lowering therapy with low LDL levels, the statement said.
Read the scientific statement for all recommendations.