Skip to main content

ORIGINAL RESEARCH article

Front. Cardiovasc. Med.
Sec. Lipids in Cardiovascular Disease
Volume 11 - 2024 | doi: 10.3389/fcvm.2024.1452869
This article is part of the Research Topic Evidence of Atherogenic Lipoproteins: what we gain from in vitro and in vivo research View all 7 articles

An equation for estimating low-density lipoprotein-triglyceride content and its use for cardiovascular disease risk stratification

Provisionally accepted
Anna Wolska Anna Wolska 1*Maureen Sampson Maureen Sampson 1Rafael Zubiran Rafael Zubiran 1Jeffrey Meeusen Jeffrey Meeusen 2Leslie J. Donato Leslie J. Donato 2Allan S. Jaffe Allan S. Jaffe 2Alan T. Remaley Alan T. Remaley 1
  • 1 National Institutes of Health (NIH), Bethesda, United States
  • 2 Mayo Clinic, Rochester, Minnesota, United States

The final, formatted version of the article will be published soon.

    Background: The triglyceride (TG) content of low-density lipoprotein (LDL-TG) has been shown to be more predictive of atherosclerotic cardiovascular disease (ASCVD) events than the cholesterol content of LDL (LDL-C). The goal of our study was to develop an equation for estimating LDL-TG (eLDL-TG) based on the standard lipid panel and to compare it to estimated LDL-C as an ASCVD risk biomarker. Methods: Using least-square regression analysis, the following eLDL-TG equation was developed: eLDL ̵TG=TG/38.5+(NonHDL¬ ̵C)/5.75+(9.75 TG)/(NonHDL ̵¬C)+244/(HDL¬ ̵C)-2.95. LDL-TG was measured by the β-quantification (BQ) reference method (N=40,202). LDL-C was calculated by the Sampson-NIH equation. The association of LDL-C and eLDL-TG with ASCVD risk markers was performed in the National Heart and Nutrition Examination Survey (NHANES) (N=37,053) and with ASCVD events in a primary prevention cohort from the UK Biobank (UKB) (N=429,367) and the Atherosclerosis Risk in Communities (ARIC) study (N=14,632). Results: eLDL-TG showed better ASCVD risk stratification of UKB participants than LDL-C (Wilcoxon Chi-Square: 2099.6 vs. 418.7, respectively). Receiving-operating characteristics analysis revealed that eLDL-TG had a stronger association with ASCVD events than LDL-C (AUC: 0.596 vs. 0.542, respectively) and other conventional lipid markers. Similar findings were found in ARIC. Discordance analysis in UKB showed that the group with low LDL-C/high eLDL-TG had a similar risk as the high LDL-C/high eLDL-TG group. Furthermore, these same two groups with the highest eLDL-TG levels and the highest ASCVD event rate also had higher mean levels of systolic blood pressure, Body Mass Index, hemoglobin A1C, and C-reactive protein than the two lower eLDL-TG groups. Using eLDL-TG >44.6 mg/dL (80th percentile) as a cut-point leads to a hazard ratio of 1.32 (95% CI, 1.29-1.36) for ASCVD events, which remained significant after adjustment for LDL-C and apoB. Furthemore, using eLDL-TG as a risk-enhancer test leads to reclassification of 50% more high-risk individuals than current lipid-enhancer test rules. Conclusions: Like LDL-C, LDL-TG can also be calculated from the results of the standard lipid panel. Compared to estimated LDL-C, eLDL-TG was a better risk marker for primary prevention and hence could improve initial ASCVD risk stratification.  

    Keywords: ASCVD, cardiovascular disease, LDL-cholesterol, LDL-triglycerides, Risk marker, risk score, triglycerides Using least-square regression analysis, the following eLDL-TG equation was

    Received: 21 Jun 2024; Accepted: 07 Oct 2024.

    Copyright: © 2024 Wolska, Sampson, Zubiran, Meeusen, Donato, Jaffe and Remaley. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Anna Wolska, National Institutes of Health (NIH), Bethesda, United States

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.