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Utilization of Advanced Lipoprotein Testing in an Academic Cardiology Practice*
236 better predicts the risk of future cardiovascular events than LDL-C. In addition, recent evidence has demonstrated that HDL particle concentration (HDL-P) is a stronger, more consistent predictor of cardiovascular disease risk than HDL-C. Purpose: To assess variations in LDL-P and HDL-P concentrations in subjects meeting an LDL-C goal of , /5 100 mg/dL and an HDL-C goal of .40 mg/dL in order to determine residual cardiovascular risk. Methods: Data were derived from a group of consecutive patients added to a large, single laboratory database (LipoScience Inc., Raleigh, North Carolina) between January 2010 and April 2012 in which both standard lipid chemistry [LDLC, HDL-C and triglycerides (TG)] and NMR lipoprotein profile data were available. Subjects were assigned to HDL-P and LDL-P categories using cut-points corresponding to the percentiles identified in the MESA study. Results: Of 19,011 subjects in the data set, 6,868 had LDL-C , /5 100 mg/dL and HDL-C .40 mg/dL. Mean subject age was 711/- 15 years (55% female) and mean plasma concentrations were LDL-C 78 1/- 15 mg/dL, LDL-P 1,049 1/- 331 nmol/L, HDL-C 56 1/- 12 mg/dL, HDL-P 36 1/- 7 umol/L and TG 105 1/- 59 mg/dL. LDL-C and LDL-P were poorly correlated (r 5 0.516), with only 46% of subjects achieving LDL-P target goals of ,1,000 nmol/L (20th MESA percentile). The correlation between HDL-C and HDL-P levels was also poor (r 5 0.516); 14% of subjects had discordantly low HDL-P levels (,29 umol/L, MESA 25th percentile). Conclusions: In this cohort who met LDL-C target goals, considerable discordance between lipoprotein particle and cholesterol measures were observed for both LDL and HDL, suggesting that quantifying lipoprotein particle concentrations may better identify residual risk for cardiovascular events.
102 HDL Particle Number in Patients with Angiographic Coronary Artery Disease on Lipid-Lowering Medication Deborah Winegar, PhD, Manuel Castro, MD, Nancy Seigle, MS, PA-C, Susan Nelson, RN, Ray Pourfarzib, PhD, (Raleigh, North Carolina)
Lead Author’s Disclosures: Dr. Winegar is employed by LipoScience Inc.
Study Funding: None Synopsis: Most patients with coronary artery disease (CAD) are treated with lipid-lowering drugs to reduce LDL cholesterol (LDL-C) to treatment goals below 100 mg/dL. While many patients are successful in achieving these goals, some continue to experience cardiovascular events. In many cases, this residual risk can be explained by elevated LDL particle (LDL-P) number however, low HDL particle (HDL-P) number (,30 umol/L) may also contribute. Purpose: To assess variations in HDL-P concentrations in patients with CAD who are receiving lipid-lowering therapy, in order to determine residual cardiovascular risk.
Journal of Clinical Lipidology, Vol 7, No 3, June 2013
Methods: Data were derived from a single laboratory database (Cardiology of Atlanta, PC). Cases were patients diagnosed with CAD by angiography who were on lipidlowering therapy and whose serum was analyzed for lipoprotein concentrations using NMR between June 2010 and March 2012. Total cholesterol, triglycerides and HDL-C were measured using standard automated methods and LDL-C was calculated using the Friedewald equation. The NMR lipoprotein profile was determined using a 400-MHz proton NMR analyzer. Results: A total of 83 patients met inclusion criteria. Of these, 78% were men and the mean age was 64 years. Mean lipid and lipoprotein levels were LDL-C: 85 1/- 30 mg/dL; LDL-P: 1364 1/- 510 nmol/L; HDL-C: 47 1/- 14 mg/dL and HDL-P: 32 1/- 7 umol/L. 78% of patients achieved LDL-C goals of ,100 mg/dL (20th MESA percentile) whereas only 23% achieved comparable LDL-P goals (,1000 nmol/L). HDL-C and HDL-P levels were moderately correlated in this cohort (r 5 0.6013) and both varied inversely with LDL-P levels. Among those that met LDL-P goals of ,1000 nmol/L, 21% had low HDL-C levels (,40 mg/dL) while 37% had low HDL-P levels (,30 umol/L HDL-P). In contrast, 35% of those with LDLP levels .1600 nmol/L (90th MESA percentile) had low HDL-C levels while 75% had low HDL-P levels. Conclusions: The majority of patients in this high risk cohort with angiographic CAD on lipid-lowering therapy met LDL-C target goals. However a significant number had low HDL-P levels and failed to achieve LDL-P goals. This suggests that they harbor residual risk for cardiovascular events and may benefit from more aggressive treatment regimes.
103 Utilization of Advanced Lipoprotein Testing in an Academic Cardiology Practice* Danielle Duffy, MD, Melissa McCarey, BA, Mounica Banala, BS, (Philadelphia, Pennsylvania)
Lead Author’s Disclosures: Dr. Duffy has received research grants from Amgen, Forest Laboratories, and Roche/Genentech. Study Funding: None Synopsis: Prospective epidemiologic studies suggest that advanced lipoprotein parameters including Apolipoprotein B (ApoB) and/or low-density lipoprotein particle concentration (LDL-P) are better predictors of cardiovascular risk than low-density lipoprotein cholesterol (LDL-C). In 2011, the National Lipid Association (NLA) released advice from an expert panel regarding the use of ApoB and LDL-P testing in clinical practice. It is unknown how this advice has been adopted and how practicing physicians view this advice. Purpose: To characterize utilization of ApoB/LDL-P testing and attitudes toward advanced lipoprotein testing in an academic cardiology practice.
Abstracts
237
Methods: An anonymous paper survey was distributed to 26 attendings and 21 fellows-in-training at an academic cardiology practice in Philadelphia, PA between July and August 2012. This 13-question survey was designed to measure knowledge, attitudes, intentions, and behaviors regarding ApoB and LDL-P testing. The results were analyzed using descriptive statistics. Results: The survey response rate was 77%, with 36 total responses from 17 attendings (65%) and 19 fellows (90%). Among survey completers, 35% of attendings and 0% of fellows report ordering ApoB or LDL-P ‘‘occasionally’’ or ‘‘frequently’’ (Figure 1). 47% of attendings and fellows intend to order ApoB or LDL-P for appropriate patients, and 35% of attendings and 37% of fellows are undecided (Figure 2). Among all respondents, 33% agree that ordering ApoB or LDL-P as advised by the NLA would be beneficial for patients, and 59% are undecided (Figure 3). A slightly larger percent of respondents agree that ordering advanced lipoprotein testing would help them to provide better quality of care (44%), although 45% remain undecided (Figure 4). Finally, 53% of respondents agree that ordering ApoB or LDL-P will help in making better treatment and management decisions, while 30% remain undecided (Figure 5). Reasons given for not ordering advanced lipoprotein testing include: lack of familiarity with NLA advice, perception that ApoB and LDL-P tests are expensive, and unfamiliarity with how to order these tests. Conclusions: In this academic cardiology practice comprised of attendings and fellows-in-training, the utilization of
advanced lipoprotein testing is low, and many providers are undecided about the benefit of such testing. There is also a large disparity between intention to utilize ApoB and LDL-P testing and actual utilization, especially among fellows. Educational efforts to increase knowledge and awareness of the clinical evidence supporting appropriate utilization of advanced lipoprotein testing, especially among cardiology fellows-in-training, could help to increase utilization of such testing.
Figure 3.
Figure 4. Figure 1.
Figure 2.
Figure 5.
102 HDL Particle Number in Patients with Angiographic Coronary Artery Disease on Lipid-Lowering Medication Deborah Winegar, PhD, Manuel Castro, MD, Nancy Seigle, MS, PA-C, Susan Nelson, RN, Ray Pourfarzib, PhD, (Raleigh, North Carolina)
Lead Author’s Disclosures: Dr. Winegar is employed by LipoScience Inc.
Study Funding: None Synopsis: Most patients with coronary artery disease (CAD) are treated with lipid-lowering drugs to reduce LDL cholesterol (LDL-C) to treatment goals below 100 mg/dL. While many patients are successful in achieving these goals, some continue to experience cardiovascular events. In many cases, this residual risk can be explained by elevated LDL particle (LDL-P) number however, low HDL particle (HDL-P) number (,30 umol/L) may also contribute. Purpose: To assess variations in HDL-P concentrations in patients with CAD who are receiving lipid-lowering therapy, in order to determine residual cardiovascular risk.
Journal of Clinical Lipidology, Vol 7, No 3, June 2013
Methods: Data were derived from a single laboratory database (Cardiology of Atlanta, PC). Cases were patients diagnosed with CAD by angiography who were on lipidlowering therapy and whose serum was analyzed for lipoprotein concentrations using NMR between June 2010 and March 2012. Total cholesterol, triglycerides and HDL-C were measured using standard automated methods and LDL-C was calculated using the Friedewald equation. The NMR lipoprotein profile was determined using a 400-MHz proton NMR analyzer. Results: A total of 83 patients met inclusion criteria. Of these, 78% were men and the mean age was 64 years. Mean lipid and lipoprotein levels were LDL-C: 85 1/- 30 mg/dL; LDL-P: 1364 1/- 510 nmol/L; HDL-C: 47 1/- 14 mg/dL and HDL-P: 32 1/- 7 umol/L. 78% of patients achieved LDL-C goals of ,100 mg/dL (20th MESA percentile) whereas only 23% achieved comparable LDL-P goals (,1000 nmol/L). HDL-C and HDL-P levels were moderately correlated in this cohort (r 5 0.6013) and both varied inversely with LDL-P levels. Among those that met LDL-P goals of ,1000 nmol/L, 21% had low HDL-C levels (,40 mg/dL) while 37% had low HDL-P levels (,30 umol/L HDL-P). In contrast, 35% of those with LDLP levels .1600 nmol/L (90th MESA percentile) had low HDL-C levels while 75% had low HDL-P levels. Conclusions: The majority of patients in this high risk cohort with angiographic CAD on lipid-lowering therapy met LDL-C target goals. However a significant number had low HDL-P levels and failed to achieve LDL-P goals. This suggests that they harbor residual risk for cardiovascular events and may benefit from more aggressive treatment regimes.
103 Utilization of Advanced Lipoprotein Testing in an Academic Cardiology Practice* Danielle Duffy, MD, Melissa McCarey, BA, Mounica Banala, BS, (Philadelphia, Pennsylvania)
Lead Author’s Disclosures: Dr. Duffy has received research grants from Amgen, Forest Laboratories, and Roche/Genentech. Study Funding: None Synopsis: Prospective epidemiologic studies suggest that advanced lipoprotein parameters including Apolipoprotein B (ApoB) and/or low-density lipoprotein particle concentration (LDL-P) are better predictors of cardiovascular risk than low-density lipoprotein cholesterol (LDL-C). In 2011, the National Lipid Association (NLA) released advice from an expert panel regarding the use of ApoB and LDL-P testing in clinical practice. It is unknown how this advice has been adopted and how practicing physicians view this advice. Purpose: To characterize utilization of ApoB/LDL-P testing and attitudes toward advanced lipoprotein testing in an academic cardiology practice.
Abstracts
237
Methods: An anonymous paper survey was distributed to 26 attendings and 21 fellows-in-training at an academic cardiology practice in Philadelphia, PA between July and August 2012. This 13-question survey was designed to measure knowledge, attitudes, intentions, and behaviors regarding ApoB and LDL-P testing. The results were analyzed using descriptive statistics. Results: The survey response rate was 77%, with 36 total responses from 17 attendings (65%) and 19 fellows (90%). Among survey completers, 35% of attendings and 0% of fellows report ordering ApoB or LDL-P ‘‘occasionally’’ or ‘‘frequently’’ (Figure 1). 47% of attendings and fellows intend to order ApoB or LDL-P for appropriate patients, and 35% of attendings and 37% of fellows are undecided (Figure 2). Among all respondents, 33% agree that ordering ApoB or LDL-P as advised by the NLA would be beneficial for patients, and 59% are undecided (Figure 3). A slightly larger percent of respondents agree that ordering advanced lipoprotein testing would help them to provide better quality of care (44%), although 45% remain undecided (Figure 4). Finally, 53% of respondents agree that ordering ApoB or LDL-P will help in making better treatment and management decisions, while 30% remain undecided (Figure 5). Reasons given for not ordering advanced lipoprotein testing include: lack of familiarity with NLA advice, perception that ApoB and LDL-P tests are expensive, and unfamiliarity with how to order these tests. Conclusions: In this academic cardiology practice comprised of attendings and fellows-in-training, the utilization of
advanced lipoprotein testing is low, and many providers are undecided about the benefit of such testing. There is also a large disparity between intention to utilize ApoB and LDL-P testing and actual utilization, especially among fellows. Educational efforts to increase knowledge and awareness of the clinical evidence supporting appropriate utilization of advanced lipoprotein testing, especially among cardiology fellows-in-training, could help to increase utilization of such testing.
Figure 3.
Figure 4. Figure 1.
Figure 2.
Figure 5.