Undiagnosed cardiovascular risk factors including elevated lipoprotein(a) in patients with ischaemic heart disease

Chua, Fionn; Lam, Aminata; Mak, Y. T.; Lee, Z; Dacay, Lily Mae; Yew, Jielin; Puar, Troy; Khoo, Joan; Chow, Weien; Tan, Vern Hsen; Tong, Khim Leng; Liew, Boon Wah; Yeo, Colin; Loh, Wann Jia

doi:10.3389/fepid.2023.1207752

Cited by 2 publications

(1 citation statement)

References 25 publications

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“…Our study did not have sufficient numbers of measurements of other lipoproteins such as VLDL cholesterol, apoB, and Lp(a) concentrations. The prescription of omega-3 fish oil supplementation was not captured in our dataset because of the low prescription rates in our local setting and likely low adherence rates related to tolerability ( 42 ). The discussions in this study serve only to generate hypotheses, and further larger studies are needed to establish the effect of hypertriglyceridaemia and other lipoprotein remnants on non-HDL-C and LDL-C, as well as to establish the clinical significance of this in our multi-ethnic population.…”

Section: Discussionmentioning

confidence: 99%

Elevated remnant cholesterol and non-HDL cholesterol concentrations from real-world laboratory results: a cross-sectional study in Southeast Asians

Loh,

Soh,

Tun

et al. 2024

Front. Cardiovasc. Med.

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IntroductionTriglyceride-rich remnant lipoproteins (TRLs) are considered atherogenic due to the presence of remnant cholesterol, which is transported by apolipoprotein B. In clinical practice, the concentration of TRLs can be estimated by calculating remnant cholesterol or non-HDL cholesterol levels.AimThis study aims to investigate the proportion of patients who have low LDL cholesterol (LDL-C) concentration but elevated remnant cholesterol concentration, stratified by the presence of hypertriglyceridaemia and ethnicity, using real-world hospital data. Our secondary aim is to investigate the proportion of patients with elevated non-HDL cholesterol levels using guideline-recommended goals.MethodsA 2-year retrospective study was conducted at a single centre, analyzing lipid blood tests of all patients, including directly measured LDL-C. Fasting for blood tests was not mandatory.ResultsThe study included a total of 21,605 consecutive patients with plasma lipid profiles analyzed in our hospital laboratory. The median age was 61 years. In patients with ASCVD (n = 14,704), 23.7% had an LDL-C level of <1.8 mmol/L, 11.3% had elevated remnant cholesterol concentrations at ≥0.65 mmol/L, and 48.8% were at the non-high-density lipoprotein cholesterol (non-HDL-C) goal (<2.6 mmol/L). Among patients diagnosed with atherosclerotic cardiovascular disease (ASCVD) with LDL-C levels of <1.8 mmol/L (n = 3,484), only 11.9% had high levels of remnant cholesterol, but 96% of the ASCVD patients also achieved the recommended non-HDL-C target of <2.6 mmol/L. When the LDL-C level was <1.8 mmol/L, the mean concentration of remnant cholesterol was 0.214 mmol/L when the triglyceride level was <1.7 mmol/L (n = 3,380), vs. 0.70 mmol/L when the triglyceride level was elevated (n = 724), p < 0.001. Among patients with a triglyceride level of ≥1.7 mmol/L and an LDL-C level of <.8 mmol/L, there were 254 patients with elevated remnant cholesterol concentration and 71 patients with suboptimal non-HDL levels. Malays had a higher mean remnant cholesterol concentration compared with both Chinese and Indians across all LDL-C levels, particularly in the presence of hypertriglyceridaemia.ConclusionsAn elevated remnant cholesterol concentration of >0.65 mmol/L was present in 11% of all patients. The current guideline-recommended non-HDL-C goal, which uses a 0.8 mmol/L estimate of remnant cholesterol concentration, was achieved in >92% of patients, suggesting that it is unlikely to be clinically useful for the majority of our patient population except where there is concomitant hypertriglyceridaemia. Further studies are needed to establish the appropriate non-HDL-C goal or calculated remnant cholesterol concentration, paired with the LDL-C goal or otherwise, in a Southeast Asian population.

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Section: Discussionmentioning

confidence: 99%

Elevated remnant cholesterol and non-HDL cholesterol concentrations from real-world laboratory results: a cross-sectional study in Southeast Asians

Loh,

Soh,

Tun

et al. 2024

Front. Cardiovasc. Med.

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Lipoprotein(a) distribution in hospitalised Asian patients with ischaemic heart disease

Loh,

Teo,

Simon

et al. 2024

Therapeutic Advances in Cardiovascular Disease

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Background: Elevated lipoprotein(a) [Lp(a)] is a common hyperlipidaemic condition with strong genetic predisposition and is independently associated with ischaemic heart disease (IHD). A Mendelian randomisation study has suggested that elevated Lp(a) is likely to confer similar causal risks as heterozygous familial hypercholesterolemia for premature IHD. We aimed to characterise the clinical profiles of admitted patients with IHD with at least one Lp(a) measurement. We also investigated whether elevated Lp(a) concentration was associated with premature onset of IHD. Methods: This is a descriptive, non-interventional, retrospective study with data from a single tertiary hospital IHD Lp(a) cohort in Singapore, which consecutively recruited 521 patients with IHD admitted to the hospital. Results: A total of 82.2% were men, 46.6% had newly diagnosed IHD and 10% had premature IHD. The median Lp(a) levels was 35.2 nmol/L. 70.8% of patients had normal Lp(a) concentrations (<70 nmol/L), 13.4% of people with Lp(a) ⩾ 70 to <120 nmol/L and 15.7% of patients with Lp(a) ⩾ 120 nmol/L. Lp(a) distribution was positively skewed to the right for all ethnicities. Patients of Indian ethnicity and of female gender had higher levels of Lp(a) compared with other ethnicities and gender, respectively. Multivariable regression analysis identified Lp(a) ⩾ 155 mmol/L to be associated with development of premature IHD (OR = 2.90, 95% CI: 1.26–6.67, p = 0.012). Conclusion: There exist differences in Lp(a) distribution across ethnicities and gender. The subgroup analysis suggests that Lp(a) ⩾ 155 mmol/L was associated with premature onset of IHD.

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Undiagnosed cardiovascular risk factors including elevated lipoprotein(a) in patients with ischaemic heart disease

Cited by 2 publications

References 25 publications

Elevated remnant cholesterol and non-HDL cholesterol concentrations from real-world laboratory results: a cross-sectional study in Southeast Asians

Elevated remnant cholesterol and non-HDL cholesterol concentrations from real-world laboratory results: a cross-sectional study in Southeast Asians

Lipoprotein(a) distribution in hospitalised Asian patients with ischaemic heart disease

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