Apolipoprotein B and non-high-density lipoprotein cholesterol reveal a high atherogenicity in individuals with type 2 diabetes and controlled low-density lipoprotein-cholesterol

• Published in: Lipids in health and disease Vol. 19; no. 1; p. 127
• Main Authors: Fonseca, Liliana, Paredes, Sílvia, Ramos, Helena, Oliveira, José Carlos, Palma, Isabel
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 06-06-2020; BioMed Central; BMC
• Subjects: Aged; ApoB; Apolipoprotein B; Apolipoproteins; Apolipoproteins B - blood; Arteriosclerosis; Atherosclerosis; Atherosclerosis - blood; Automation; Blood cholesterol; Cardiovascular disease; Cardiovascular diseases; Cholesterol; Cholesterol, HDL - blood; Cholesterol, LDL - blood; Creatinine; CV risk; CVD; Diabetes; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - blood; Diabetes therapy; Drugs; Dyslipidemia; Dyslipidemias - drug therapy; Electronic health records; Female; Glucose; High density lipoprotein; Homocysteine; Humans; Laboratories; LDL-c; Lipids; Lipoproteins; Lipoproteins - blood; Lipoproteins, LDL - blood; Low density lipoprotein; Low density lipoproteins; Male; Medical records; Metabolic disorders; Metabolism; Middle Aged; Mortality; Non-HDL cholesterol; Patients; Practice Guidelines as Topic; Reference Values; Retrospective Studies; Risk assessment; Risk Factors; Risk groups; Statins; Statistical analysis; Triglycerides; Type 2 diabetes; Uric acid; Women; Germany; CVD; T2DM; Non-HDL cholesterol; LDL-c; CV risk; Dyslipidemia; ApoB
• ISSN: 1476-511X; 1476-511X
• DOI: 10.1186/s12944-020-01292-w

Lipid-lowering therapy is guided by Low-density-lipoprotein cholesterol (LDL-c) levels, although the cardiovascular disease (CVD) risk could be better reflected by other lipid parameters. This study aimed at comparing a comprehensive lipid profile between patients with type 2 diabetes mellitus (T2DM) with LDL-c concentration within and above target.
A comprehensive lipid profile was characterized in 96 T2DM patients. The European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) 2016 and 2019 Guidelines for the Management of Dyslipidemias were used to define LDL-c targets.
In this population, only 28.1 and 16.7% of patients had mean LDL-c levels within target, as defined by the 2016 and 2019 guidelines, respectively. Applying the 2016 guidelines criteria, in patients with LDL-c within target, 22, 25 and 44% presented non-high-density lipoprotein cholesterol (non-HDL-c), Apolipoprotein B (ApoB) and oxidized LDL-c levels above the recommended range, respectively, whereas according to the 2019 guidelines criteria, 50, 39 and 44% of the patients with LDL-c within target had elevated high-density lipoprotein cholesterol (HDL-c), ApoB and oxidized LDL-c levels, respectively. LDL-c was strongly correlated with non-HDL-c (r = 0.850), ApoB (r = 0.656) and oxidized LDL-c (r = 0.508). Similarly, there was a strong correlation between non-HDL-c with both ApoB (r = 0.808) and oxidized LDL-c (r = 0.588).
These findings emphasize the limitations of only considering LDL-c concentration for cardiovascular (CV) risk assessment. Targeting only LDL-c could result in missed opportunities for CV risk reduction in T2DM patients. These data suggest that non-HDL-c, ApoB and oxidized LDL-c levels could be considered as an important part of these patients' evaluation allowing for a more accurate estimation of CV risk and hopefully better management of these high-risk patients.