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Quantifying atherogenic lipoproteins – pragmatic guidance from the EAS/EFLM Joint Consensus paper
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Quantifying atherogenic lipoproteins for lipid-lowering strategies: consensus-based recommendations from EAS and EFLM.

A Joint Consensus Initiative from the EAS and the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM).

Publication in full

Slide set

Authors

Børge G. Nordestgaard, Michel R. Langlois, Anne Langsted, M. John Chapman, Kristin M. Aakred, Hannsjörg Baume, Jan Borén, Eric Bruckert, Alberico Catapano,Christa Cobbaerti, Paul Collinson, Olivier S. Descamps, Christopher J. Duff, Arnold von Eckardstein, Angelika Hammerer-Lercher, Pia R. Kamstrup, Genovefa Kolovou, Florian Kronenberg, Samia Mora, Kari Pulkki, Alan T. Remaley, Nader Rifai, Emilio Ros, Sanja Stankovic, Ana Stavljenic-Rukavina, Grazyna Sypniewska, Gerald F. Watts, Olov Wiklund, Päivi Laitinenz for the European Atherosclerosis Society (EAS) and the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) Joint Consensus Initiative

Summary

The joint consensus panel of the European Atherosclerosis Society (EAS) and the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) recently addressed present and future challenges in the laboratory diagnostics of atherogenic lipoproteins. Total cholesterol, triglycerides, HDL cholesterol, LDL cholesterol, and calculated non-HDL cholesterol (=total – HDL cholesterol) constitute the primary lipid panel for estimating risk of atherosclerotic cardiovascular disease (ASCVD) and can be measured in the nonfasting state. LDL cholesterol is the primary target of lipid-lowering therapies. For on-treatment follow-up, LDL cholesterol shall be measured or calculated by the same method to attenuate errors in treatment decisions due to marked between-method variations. Lipoprotein(a)-cholesterol is part of measured or calculated LDL cholesterol and should be estimated at least once in all patients at risk of ASCVD, especially in those whose LDL cholesterol decline poorly upon statin treatment. Residual risk of ASCVD even under optimal LDL-lowering treatment should be also assessed by non-HDL cholesterol or apolipoprotein B, especially in patients with mild-to-moderate hypertriglyceridemia (2–10 mmol/L). Non-HDL cholesterol includes the assessment of remnant lipoprotein cholesterol and shall be reported in all standard lipid panels. Additional apolipoprotein B measurement can detect elevated LDL particle numbers often unidentified on the basis of LDL cholesterol alone. Reference intervals of lipids, lipoproteins, and apolipoproteins are reported for European men and women aged 20–100 years. However, laboratories shall flag abnormal lipid values with reference to therapeutic decision thresholds.

Commentary

Quantifying atherogenic lipoproteins – pragmatic guidance from the EAS/EFLM Joint Consensus Initiative

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