Advanced Lipid Thinking Prior to Incorporating Advanced Lipid Testing

Kent Brummel, Nilay Shah, Neil J Stone*

*Corresponding author for this work

Research output: Contribution to journalReview article

Abstract

Lipid profiles help estimate patient's short- and long-term atherosclerotic cardiovascular disease risk over the life course and inform treatment decisions. Advanced lipid testing can provide additional information in selected patients. New 2018 cholesterol guidelines suggest which patients may benefit from additional testing. In patients ages 40-75 years, calculation of a 10-year atherosclerotic cardiovascular disease risk score begins the clinician–patient risk discussion. In those at intermediate risk (10-year risk 7.5%-19.9%) for future events, inclusion of enhancing factors personalizes the risk decision. The guidelines identify enhancing factors that can support initiating statin therapy. Two advanced lipid tests may be used. Apolipoprotein B levels improve risk estimations and identify genetic disorders in hypertriglyceridemic patients. In patients with a family history of premature atherosclerotic cardiovascular disease, significantly elevated lipoprotein (a) levels may reclassify risk. The decision-making cascade of estimating 10-year risk, personalizing risk status with risk-enhancing factors, and, if appropriate, reclassifying risk with a coronary artery calcium score is advanced lipid thinking that can utilize advanced lipid testing to optimize atherosclerotic cardiovascular disease prevention.

Original languageEnglish (US)
JournalAmerican Journal of Medicine
DOIs
StatePublished - Jan 1 2019

Fingerprint

Lipids
Cardiovascular Diseases
Thinking
Guidelines
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Inborn Genetic Diseases
Lipoprotein(a)
Apolipoproteins B
Coronary Vessels
Decision Making
Cholesterol
Calcium
Therapeutics

Keywords

  • Advanced lipid testing
  • Apolipoprotein B
  • Coronary artery calcium score
  • Guidelines
  • Lipoprotein (a)

ASJC Scopus subject areas

  • Medicine(all)

Cite this

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abstract = "Lipid profiles help estimate patient's short- and long-term atherosclerotic cardiovascular disease risk over the life course and inform treatment decisions. Advanced lipid testing can provide additional information in selected patients. New 2018 cholesterol guidelines suggest which patients may benefit from additional testing. In patients ages 40-75 years, calculation of a 10-year atherosclerotic cardiovascular disease risk score begins the clinician–patient risk discussion. In those at intermediate risk (10-year risk 7.5{\%}-19.9{\%}) for future events, inclusion of enhancing factors personalizes the risk decision. The guidelines identify enhancing factors that can support initiating statin therapy. Two advanced lipid tests may be used. Apolipoprotein B levels improve risk estimations and identify genetic disorders in hypertriglyceridemic patients. In patients with a family history of premature atherosclerotic cardiovascular disease, significantly elevated lipoprotein (a) levels may reclassify risk. The decision-making cascade of estimating 10-year risk, personalizing risk status with risk-enhancing factors, and, if appropriate, reclassifying risk with a coronary artery calcium score is advanced lipid thinking that can utilize advanced lipid testing to optimize atherosclerotic cardiovascular disease prevention.",
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Advanced Lipid Thinking Prior to Incorporating Advanced Lipid Testing. / Brummel, Kent; Shah, Nilay; Stone, Neil J.

In: American Journal of Medicine, 01.01.2019.

Research output: Contribution to journalReview article

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