Quantifying atherogenic lipoproteins for lipid-lowering strategies: Consensus-based recommendations from EAS and EFLM.

Børge G Nordestgaard, Michel R Langlois, Anne Langsted, M John Chapman, Kristin M Aakre, Hannsjörg Baum, Jan Borén, Eric Bruckert, Alberico Catapano, Christa Cobbaert, Paul Collinson, Olivier S Descamps, Christopher J Duff, Arnold von Eckardstein, Angelika Hammerer-Lercher, Pia R Kamstrup, Genovefa Kolovou, Florian Kronenberg, Samia Mora, Kari Pulkki, Alan T Remaley, Nader Rifai, Emilio Ros, Sanja Stankovic, Ana Stavljenic-Rukavina, Grazyna Sypniewska, Gerald F Watts, Olov Wiklund, Päivi Laitinen

Journal: Atherosclerosis 2021;294():46-61

PMID: 31928713

Abstract

The joint consensus panel of the European Atherosclerosis Society (EAS) and the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) recently addressed present and future challenges in the laboratory diagnostics of atherogenic lipoproteins. Total cholesterol, triglycerides, HDL cholesterol, LDL cholesterol, and calculated non-HDL cholesterol (=total - HDL cholesterol) constitute the primary lipid panel for estimating risk of atherosclerotic cardiovascular disease (ASCVD) and can be measured in the nonfasting state. LDL cholesterol is the primary target of lipid-lowering therapies. For on-treatment follow-up, LDL cholesterol shall be measured or calculated by the same method to attenuate errors in treatment decisions due to marked between-method variations. Lipoprotein(a)-cholesterol is part of measured or calculated LDL cholesterol and should be estimated at least once in all patients at risk of ASCVD, especially in those whose LDL cholesterol decline poorly upon statin treatment. Residual risk of ASCVD even under optimal LDL-lowering treatment should be also assessed by non-HDL cholesterol or apolipoprotein B, especially in patients with mild-to-moderate hypertriglyceridemia (2-10 mmol/L). Non-HDL cholesterol includes the assessment of remnant lipoprotein cholesterol and shall be reported in all standard lipid panels. Additional apolipoprotein B measurement can detect elevated LDL particle numbers often unidentified on the basis of LDL cholesterol alone. Reference intervals of lipids, lipoproteins, and apolipoproteins are reported for European men and women aged 20-100 years. However, laboratories shall flag abnormal lipid values with reference to therapeutic decision thresholds.

Copyright © 2019 Elsevier B.V. All rights reserved.

Address: Herlev and Gentofte Hospital, Copenhagen University Hospital, University of Copenhagen, Denmark. Electronic address: [email protected].; Department of Laboratory Medicine, AZ St-Jan, Brugge, University of Ghent, Belgium. Electronic address: [email protected].; Herlev and Gentofte Hospital, Copenhagen University Hospital, University of Copenhagen, Denmark.; National Institute for Health and Medical Research (INSERM), and Endocrinology-Metabolism Service, Pitié-Salpetriere University Hospital, Paris, France.; Hormone Laboratory, Haukeland University Hospital, Bergen, Norway.; Institute for Laboratory Medicine, Mikrobiologie und Blutdepot, Regionale Kliniken Holding RKH GmbH, Ludwigsburg, Germany.; Institute of Medicine, Sahlgrenska Academy at Göteborg University, Wallenberg Laboratory for Cardiovascular and Metabolic Research, Sahlgrenska University Hospital, Gothenburg, Sweden.; Department of Endocrinology and prevention of cardiovascular disease, Pitié-Salpetriere University Hospital, Paris, France.; Department of Pharmacological and Biomolecular Sciences, University of Milan, and IRCCS Multimedica, Milan, Italy.; Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Leiden, the Netherlands.; Departments of Clinical Blood Sciences and Cardiology, St George's University Hospitals NHS Foundation Trust and St George's University of London, London, UK.; Department of Internal Medicine, Centres Hospitaliers Jolimont, Haine-Saint-Paul, Department of Cardiology, UCL Cliniques Universitaires Saint-Luc, Brussels, Belgium.; Department of Clinical Biochemistry, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK.; Institute for Clinical Chemistry, University Hospital Zurich, Zurich, Switzerland.; Kantonspital Aarau AG, Institute for Laboratory Medicine, Aarau, Switzerland.; Cardiology Department, Onassis Cardiac Surgery Center, Athens, Greece.; Department of Medical Genetics, Molecular and Clinical Pharmacology, Division of Genetic Epidemiology, Medical University of Innsbruck, Innsbruck, Austria.; Divisions of Preventive and Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.; Department of Clinical Chemistry, University of Turku and Turku University Hospital, Turku, Finland.; Lipoprotein Metabolism Section, Cardiovascular-Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA.; Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.; Lipid Clinic, Department of Endocrinology and Nutrition, Institut d'Investigacions Biomèdiques August Pi Sunyer, Hospital Clínic, Barcelona and Ciber Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Spain.; Center for Medical Biochemistry, Clinical Center of Serbia, Belgrade, Serbia.; Libertas International University, Zagreb, Croatia.; Dept. of Laboratory Medicine, Collegium Medicum, NC University, Bydgoszcz, Poland.; Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, University of Western Australia, Perth, Australia.; Department of Clinical Chemistry, HUSLAB, Helsinki University Hospital, Helsinki, Finland.
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