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Diagnosis of Fredrickson-Levy-Lees dyslipidemias inconsistent
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PHILADELPHIA — A variance in the two qualitative approaches to diagnose patients with Fredrickson-Levy-Lees dyslipidemias may explain the prevalence of lipoprotein disorders compared with previous reports, according to a poster presented at the National Lipid Association Scientific Sessions.
“Right now, a lot of dyslipidemia diagnosis is simplified to evaluating LDL and triglycerides to make a diagnosis and subsequently treat patients,” Vasanth Sathiyakumar, MD, a medical resident at Johns Hopkins University, told Cardiology Today. “What we want to do in this analysis is look at the prevalence of Fredrickson-Levy-Lees dyslipidemias and really tie therapy to the specific lipoprotein elevation.”
Researchers analyzed data from 309,783 patients (median age, 56; 44% men) to determine the differences between the two qualitative approaches to diagnose patients with dyslipidemia: separation of lipoproteins by rapid ultracentrifugation and measurement of plasma apolipoprotein B, triglycerides and total cholesterol.
The incidence of dyslipidemia differed between the two groups, as a normal diagnosis was found in 86% of the ultracentrifugation group vs. 55% in the apolipoprotein B, triglycerides and total cholesterol group.
The prevalence of Frederickson-Levy-Lees phenotypes was inconsistent in the ultracentrifugation group vs. the algorithm group, especially for Type I (0% vs. 0.03%, respectively), Type IIa (8.6% vs. 3.3%, respectively), Type IIb (1.1% vs. 11.1%, respectively), Type III (0.2% vs. 2.7%, respectively), Type IV (3.7% vs. 27.5%, respectively) and Type V (0.04% vs. 0.14%, respectively). The type III phenotype was more widespread than previously reported, according to the abstract.
Among both groups, the overall concordance was 59.8%.
“The two methods do differ to a certain degree,” Sathiyakumar said in an interview with Cardiology Today. “What is remarkable, however, is despite the inherent differences in the algorithms, the prevalence of what was historically thought to be seemingly rare disorders is actually much more common. There certainly needs to be much more research in terms of finding appropriate cutpoints and harmonizing these algorithms to diagnose these phenotypic disorders. Recognizing prevalence is an important first step.” – by Darlene Dobkowski
Reference:
Sathiyakumar V, et al. Abstract 116. Presented at: National Lipid Association Scientific Sessions; May 18-21, 2017; Philadelphia.
Disclosure: Sathiyakumar reports no relevant financial disclosures.