Transitioning from population to individualized preventive cardiology
Pamela B Morris,1 Richard F Wright2
1Seinsheimer Cardiovascular Health Program and Women’s Heart Care, Medical University of South Carolina, Charleston, SC, USA; 2Heart Failure Center, Pacific Heart Institute, Santa Monica, CA, USA
Abstract: There is an ongoing discussion about whether treatment strategies developed from population based studies lead to inappropriate care of individual patients. This article proposes that despite management of lipid-lowering therapy to established low-density lipoprotein cholesterol (LDL-C) goals, significant residual risk for cardiovascular events remains in patients with established cardiovascular disease, diabetes, and metabolic syndrome (ie, central obesity, raised triglyceride levels and/or reduced high-density lipoprotein cholesterol levels). In these patients, LDL-C is often an inaccurate predictor of risk because the cholesterol content within the low-density lipoprotein particle (LDL-P) can be highly variable and thus LDL-C often inaccurately expresses an individual's likelihood of an atherosclerotic event. The LDL-P number has been found to be a better discriminator of cardiovascular risk than LDL-C in individual patients in several large epidemiologic studies that use sub-group analyses, including the Framingham Offspring Study and the Multi-Ethnic Study of Atherosclerosis. In contrast, epidemiology studies that utilize population statistics focusing on the role of lipids for initial risk assessment in entire populations do not separately evaluate these higher risk patients. The measurement of LDL-P in patients with cardiometabolic risk allows treatment of individuals through the optimization of lipid-lowering therapy to personalized goals, which would be expected to reduce that individual's risk of subsequent atherosclerotic events.
Keywords: cardiovascular disease, individualized medicine, low-density lipoprotein particles, low-density lipoprotein cholesterol
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