Comparison of Recommendations: Lipoprotein and Apolipoprotein Assessments
Lipoprotein and Apolipoprotein Assessments.
Class III: No Benefit.
Measurement of lipid parameters, including lipoproteins, apolipoproteins, particle size, and density, beyond a standard fasting lipid profile is not recommended for cardiovascular risk assessment in asymptomatic adults (Ip et al, 2009). (Level of Evidence: C)
Recommendations for LDL Subclasses and Particle Size
Lipoprotein subclasses, especially the number or concentration of small, dense LDL particles, have been shown to be related to the development of initial CHD events, but the data analyses of existing studies are generally not adequate to show added benefit over standard risk assessment for primary prevention. (Classification of recommendation: III [lipoprotein subclass determination is not recommended], Level of evidence: A)
There are insufficient data that measurement of lipoprotein subclasses over time is useful to evaluate the effects of treatments. (Classification of recommendation: III; Level of evidence: C)
Several methods are available to assess lipoprotein subclasses. Standardization is needed for this technology. (Classification of recommendation: IIa; Level of evidence: C)
Recommendations for Lipoprotein(a)
Lipoprotein (a) screening is not warranted for primary prevention and assessment of cardiovascular risk. (Classification of recommendation: III [against measurement]; Level of evidence: A)
If risk is intermediate (10% to 20%) and uncertainty remains as to the use of preventive therapies such as statins or aspirin, then lipoprotein (a) measurement may be done at the physician's discretion. (Classification of recommendations: IIb; Level of evidence: C)
After global risk assessment, lipoprotein (a) measurements in patients with a strong family history of premature CVD may be useful for identifying individuals having a genetic predisposition of CVD. (Classification of recommendation: IIb; Level of evidence: C)
The benefits of therapies based on lipoprotein (a) concentrations are uncertain. If both lipoprotein (a) and LDL-C are highly increased, an attempt can be made at the physician's discretion to lower lipoprotein (a) level by lowering the elevated LDL-C. (Classification of recommendation: IIb; Level of evidence: C)
Recommendations for Apolipoproteins A-I and B
The first step to monitor efficacy of lipid lowering therapies is to measure LDL-C (and non-HDL-C in patients with elevated triglycerides). (Classification of recommendation: I; Level of evidence: A)
Although apo B measures atherogenic lipoproteins and is a good predictor of CVD risk (equal at least to LDL-C and non-HDL-C), it is only a marginally better predictor than the current lipid profile and should not be routinely measured at this time for use in global risk assessment. (Classification of recommendation: IIa [against measurement]; Level of evidence: B)
Measurement of apo B can be used to monitor efficacy of lipid-lowering therapies as an alternative to non-HDL-C. (Classification of recommendation: IIb; Level of evidence: B)
The apo B/apo A-I ratio can be used as an alternative to the usual total cholesterol/HDL-C ratio to determine lipoprotein-related risk for CVD. (Classification of recommendation: IIa; Level of evidence: A)
The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of using the nontraditional risk factors discussed in this statement* to screen asymptomatic men and women with no history of CHD to prevent CHD events. This is an I statement.
*hs-CRP, ABI, leukocyte count, fasting blood glucose level, periodontal disease, carotid IMT, CAC score on EBCT [electron-beam CT], homocysteine level, and lipoprotein(a) level.
AHRQ © 2012
Agency for Healthcare Research and Quality (AHRQ)
Cite this: Assessing Cardiovascular Risk: Guideline Synthesis - Medscape - Mar 01, 2012.