Elevated remnant cholesterol and non-HDL cholesterol concentrations from real-world laboratory results: a cross-sectional study in Southeast Asians
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...
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Frontiers Media S.A.
2024-02-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2024.1328618/full |
| _version_ | 1797322501147066368 |
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| author | Wann Jia Loh Wann Jia Loh Heng Samuel Soh Mon Hnin Tun Pei Ting Tan Chin Shern Lau Subramaniam Tavintharan Gerald F. Watts Gerald F. Watts Tar Choon Aw Tar Choon Aw |
| author_facet | Wann Jia Loh Wann Jia Loh Heng Samuel Soh Mon Hnin Tun Pei Ting Tan Chin Shern Lau Subramaniam Tavintharan Gerald F. Watts Gerald F. Watts Tar Choon Aw Tar Choon Aw |
| author_sort | Wann Jia Loh |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-08T05:15:11Z |
| format | Article |
| id | doaj.art-822fc8cb16bf44e0b5efc80938125889 |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-03-08T05:15:11Z |
| publishDate | 2024-02-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-822fc8cb16bf44e0b5efc809381258892024-02-07T04:35:28ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2024-02-011110.3389/fcvm.2024.13286181328618Elevated remnant cholesterol and non-HDL cholesterol concentrations from real-world laboratory results: a cross-sectional study in Southeast AsiansWann Jia Loh0Wann Jia Loh1Heng Samuel Soh2Mon Hnin Tun3Pei Ting Tan4Chin Shern Lau5Subramaniam Tavintharan6Gerald F. Watts7Gerald F. Watts8Tar Choon Aw9Tar Choon Aw10Department of Endocrinology, Changi General Hospital, Singapore, SingaporeDuke-NUS Medical School, Singapore, SingaporeDepartment of Cardiology, Changi General Hospital, Singapore, SingaporeHealth Services Research Unit, Changi General Hospital, Singapore, SingaporeClinical Trial and Research Unit, Changi General Hospital, Singapore, SingaporeDepartment of Laboratory Medicine, Changi General Hospital, Singapore, SingaporeDiabetes Centre, Admiralty Medical Centre, Singapore, SingaporeMedical School, University of Western Australia, Perth, WA, AustraliaDepartment of Cardiology and Internal Medicine, Royal Perth Hospital, Perth, WA, AustraliaDuke-NUS Medical School, Singapore, SingaporeDepartment of Laboratory Medicine, Changi General Hospital, Singapore, SingaporeIntroductionTriglyceride-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.https://www.frontiersin.org/articles/10.3389/fcvm.2024.1328618/fullhypercholesterolaemiaLDL targetsnon-HDL cholesterolremnant cholesteroltriglyceride-rich lipoproteinAsian ethnicity |
| spellingShingle | Wann Jia Loh Wann Jia Loh Heng Samuel Soh Mon Hnin Tun Pei Ting Tan Chin Shern Lau Subramaniam Tavintharan Gerald F. Watts Gerald F. Watts Tar Choon Aw Tar Choon Aw Elevated remnant cholesterol and non-HDL cholesterol concentrations from real-world laboratory results: a cross-sectional study in Southeast Asians Frontiers in Cardiovascular Medicine hypercholesterolaemia LDL targets non-HDL cholesterol remnant cholesterol triglyceride-rich lipoprotein Asian ethnicity |
| title | Elevated remnant cholesterol and non-HDL cholesterol concentrations from real-world laboratory results: a cross-sectional study in Southeast Asians |
| title_full | Elevated remnant cholesterol and non-HDL cholesterol concentrations from real-world laboratory results: a cross-sectional study in Southeast Asians |
| title_fullStr | Elevated remnant cholesterol and non-HDL cholesterol concentrations from real-world laboratory results: a cross-sectional study in Southeast Asians |
| title_full_unstemmed | Elevated remnant cholesterol and non-HDL cholesterol concentrations from real-world laboratory results: a cross-sectional study in Southeast Asians |
| title_short | Elevated remnant cholesterol and non-HDL cholesterol concentrations from real-world laboratory results: a cross-sectional study in Southeast Asians |
| title_sort | elevated remnant cholesterol and non hdl cholesterol concentrations from real world laboratory results a cross sectional study in southeast asians |
| topic | hypercholesterolaemia LDL targets non-HDL cholesterol remnant cholesterol triglyceride-rich lipoprotein Asian ethnicity |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2024.1328618/full |
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