A simple multiplier to calculate the impact of HDL cholesterol on cardiovascular risk estimation using SCORE
ABSTRACT The 2011 ESC-EAS guidelines on the management of dyslipidaemias use four separate charts to illustrate the impact of differing HDL cholesterol levels on risk of cardiovascular disease. We developed an easy way to calculate the effects of differing HDL-C levels on risk by deriving HDL and sex specific multipliers and applying these to various reference charts. Of three strategies explored, one based on a low HDL (0.8 mmol/l) reference chart was the simplest and was acceptably accurate. Such an approach simplifies risk estimation by avoiding the need for multiple charts.
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ABSTRACT: Background Despite international standardization programs for LDLc and HDLc measurements, results vary significantly with methods from different manufacturers. We aimed to simulate the impact of analytical error and hypertriglyceridemia on HDLc- and LDLc-based cardiovascular risk classification. Methods From the Dutch National EQA-2012 external quality assessment of 200 clinical laboratories, we examined data from normotriglyceridemic (∼1 mmol/l) and hypertriglyceridemic (∼7 mmol/l) serum pools with lipid target values assigned by the Lipid Reference Laboratory in Rotterdam. HDLc and LDLc were measured using direct methods of Abbott, Beckman, Siemens, Roche, Olympus, or Ortho Clinical Diagnostics. We simulated risk reclassification using HDL- and sex-specific SCORE multipliers considering two fictitious moderate-risk patients with initial SCORE 4% (man) and 3% (woman). Classification into high-risk treatment groups (LDLc >2.50 mmol/l) was compared between calculated LDLc and direct LDLc methods. Results Overall HDLc measurements in hypertriglyceridemic serum showed negative mean bias of -15%. HDL-multipliers falsely reclassified 70% of women and 43% of men to a high-risk (SCORE>5%) in hypertriglyceridemic serum (P<0.0001 vs. normotriglyceridemic serum) with method-dependent risk reclassifications. Direct LDLc in hypertriglyceridemic serum showed positive mean bias with Abbott (+16%) and Beckman (+14%) and negative mean bias with Roche (-7%). In hypertriglyceridemic serum, 57% of direct LDLc measurements were above high-risk treatment goal (2.50 mmol/l) vs. 29% of direct LDLc (33% of calculated LDLc) in normotriglyceridemic sera. Conclusion LDLc and HDLc measurements are unreliable in severe hypertriglyceridemia, and should be applied with caution in SCORE risk classification and therapeutic strategies.Atherosclerosis 03/2014; 233(1). DOI:10.1016/j.atherosclerosis.2013.12.016 · 3.97 Impact Factor
Atherosclerosis 10/2012; 226(1). DOI:10.1016/j.atherosclerosis.2012.10.036 · 3.97 Impact Factor