Modern prevalence of dysbetalipoproteinemia (Fredrickson-Levy-Lees type III hyperlipoproteinemia).

Dysbetalipoproteinaemia (HLP3) is a disorder characterized by excess cholesterol-enriched, triglyceride-rich lipoprotein remnants in genetically predisposed individuals that powerfully promote premature cardiovascular disease if untreated. The current prevalence of HLP3 is largely unknown. We performed cross-sectional analysis of 128,485 U.S. adults from the Very Large Database of Lipids (VLDbL), using four algorithms to diagnose HLP3 employing three Vertical Auto Profile ultracentrifugation (UC) criteria and a previously described apolipoprotein B (apoB) method. We evaluated 4,926 participants from the 2011-2014 National Health and Nutrition Examination Survey (NHANES) with the apoB method. We examined demographic and lipid characteristics stratified by presence of HLP3 and evaluated lipid characteristics in those with HLP3 phenotype discordance and concordance as determined by apoB and originally defined UC criteria 1. In U.S. adults in VLDbL and NHANES, a 1.7-2.0% prevalence is observed for HLP3 with the novel apoB method as compared to 0.2-0.8% prevalence in VLDbL via UC criteria 1-3. Participants who were both apoB and UC criteria HLP3 positive had higher remnant particles as well as more elevated triglyceride/apoB and total cholesterol/apoB ratios (all HLP3 may be more prevalent than historically and clinically appreciated. The apoB method increases HLP3 identification via inclusion of milder phenotypes. Further work should evaluate the clinical implications of HLP3 diagnosis at various lipid algorithm cut-points to evaluate the ideal standard in the modern era.

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Copyright: © 2019 Termedia & Banach.

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VAP, VS, JP, RMV, MLE, EB, RQ, EG, MB, RSB, DM and ADS have no relevant disclosures. PPT: Speakers Bureau; Amarin, Akcea, Amgen, Kowa, Merck, Nova Nordisk, Regeneron, Sanofi (Consultant/Advisory Board). SRJ: Co-inventor for a method to estimate LDL cholesterol levels, patent application pending; funding from the David and June Trone Family Foundation. DS: personal fees from Amgen Inc, Akcea Therapeutics, Medicure, Sanofi, Regeneron; personal fees from the National Lipid Association outside the submitted work. SSM: Co-inventor for a method to estimate LDL cholesterol levels, patent application pending; Consultant/Advisory Board for Sanofi/Regeneron, Amgen, Quest Diagnostics, Akcea, Novo Nordisk, Esperion.