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Hypercholesterolemia: HELP
Articles by Michael J. Blaha
Based on 14 articles published since 2010
(Why 14 articles?)
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Between 2010 and 2020, Michael J. Blaha wrote the following 14 articles about Hypercholesterolemia.
 
+ Citations + Abstracts
1 Editorial Waiting for the National Cholesterol Education Program Adult Treatment Panel IV Guidelines, and in the meantime, some challenges and recommendations. 2012

Martin, Seth S / Metkus, Thomas S / Horne, Aaron / Blaha, Michael J / Hasan, Rani / Campbell, Catherine Y / Yousuf, Omair / Joshi, Parag / Kaul, Sanjay / Miller, Michael / Michos, Erin D / Jones, Steven R / Gluckman, Ty J / Cannon, Christopher P / Sperling, Laurence S / Blumenthal, Roger S. · ·Am J Cardiol · Pubmed #22497674.

ABSTRACT: The National Cholesterol Education Program Adult Treatment Panel (ATP) has provided education and guidance for decades on the management of hypercholesterolemia. Its third report (ATP III) was published 10 years ago, with a white paper update in 2004. There is a need for translation of more recent evidence into a revised guideline. To help address the significant challenges facing the ATP IV writing group, this statement aims to provide balanced recommendations that build on ATP III. The authors aim for simplicity to increase the likelihood of implementation in clinical practice. To move from ATP III to ATP IV, the authors recommend the following: (1) assess risk more accurately, (2) simplify the starting algorithm, (3) prioritize statin therapy, (4) relax the follow-up interval for repeat lipid testing, (5) designate <70 mg/dl as an "ideal" low-density lipoprotein cholesterol target, (6) endorse targets beyond low-density lipoprotein cholesterol, (7) refine therapeutic target levels to the equivalent population percentile, (8) remove misleading descriptors such as "borderline high," and (9) make lifestyle messages simpler. In conclusion, the solutions offered in this statement represent ways to translate the totality of published reports into enhanced hyperlipidemia guidelines to better combat the devastating impact of hyperlipidemia on cardiovascular health.

2 Review Personalizing Treatment: Between Primary and Secondary Prevention. 2016

Blaha, Michael J. ·Ciccarone Center for the Prevention of Heart Disease and Department of Epidemiology, Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: mblaha1@jhmi.edu. ·Am J Cardiol · Pubmed #27620358.

ABSTRACT: Current American College of Cardiology/American Heart Association guidelines for the management of patients with elevated blood cholesterol increasingly emphasize assessment of atherosclerotic cardiovascular disease (ASCVD) risk in deciding when to initiate pharmacotherapy. The decision to treat is based primarily on mathematical integration of traditional risk factors, including age, sex, race, lipid values, systolic blood pressure, hypertension therapy, diabetes mellitus, and smoking. Advanced risk testing is selectively endorsed for patients when the decision to treat is otherwise uncertain, or more broadly interpreted as those patients who are at so-called "intermediate risk" of ASCVD events using traditional risk factors alone. These new guidelines also place new emphasis on a clinician-patient risk discussion, a process of shared decision making in which patient and physician consider the potential benefits of treatment, risk of adverse events, and patient preferences before making a final decision to initiate treatment. Advanced risk testing is likely to play an increasingly important role in this process as weaknesses in exclusive reliance on traditional risk factors are recognized, new non-statin therapies become available, and guidelines are iteratively updated. Comparative efficacy studies of the various advanced risk testing options suggest that coronary artery calcium scoring is most strongly predictive of ASCVD events. Most importantly, coronary artery calcium scoring appears to identify an important subgroup of patients with advanced subclinical atherosclerosis-who are "between" primary and secondary prevention-that might benefit from the most aggressive lipid-lowering pharmacotherapy.

3 Review 2013 ACC/AHA cholesterol treatment guideline: what was done well and what could be done better. 2014

Martin, Seth S / Abd, Thura T / Jones, Steven R / Michos, Erin D / Blumenthal, Roger S / Blaha, Michael J. ·Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland. · Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland. Electronic address: mblaha1@jhmi.edu. ·J Am Coll Cardiol · Pubmed #24681146.

ABSTRACT: Five years after convening the expert panel, the 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults was released. The American College of Cardiology and American Heart Association issued the guideline on the basis of a systematic review of cholesterol treatment trials performed by the National Heart, Lung, and Blood Institute. This report critically appraises the guideline and provides our view of what was done well and what could be done better. In particular, we propose that the guideline succeeds in prioritizing statin therapy, expanding the focus to atherosclerotic cardiovascular disease (including stroke), and emphasizing absolute cardiovascular risk to determine eligibility for statin therapy. We contend that the guideline could be enhanced by refining the use of lipid goals rather than removing them, enhancing guidance on evaluation of cholesterol, and broadening the concept of age underpinning risk-based decision making to include vascular and physiological age. We further suggest that the next guideline panel could comprehensively review current best evidence, build on existing guidelines, and cultivate broader national and international consensus. Overall, we aim to continue discussions about the important contributions and shortfalls of the guideline and create momentum for effective implementation and timely updates.

4 Review Niacin and statin combination therapy for atherosclerosis regression and prevention of cardiovascular disease events: reconciling the AIM-HIGH (Atherothrombosis Intervention in Metabolic Syndrome With Low HDL/High Triglycerides: Impact on Global Health Outcomes) trial with previous surrogate endpoint trials. 2012

Michos, Erin D / Sibley, Christopher T / Baer, Jefferson T / Blaha, Michael J / Blumenthal, Roger S. ·The Johns Hopkins University School of Medicine, Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland 21287, USA. edonnell@jhmi.edu ·J Am Coll Cardiol · Pubmed #22520249.

ABSTRACT: Despite substantial risk reductions targeting low-density lipoprotein cholesterol with statins, there remains significant residual risk as evidenced by incident and recurrent cardiovascular disease (CVD) events among statin-treated patients. Observational studies have shown that low levels of high-density lipoprotein cholesterol (HDL-C) are associated with increased CVD risk. It remains unclear whether strategies aimed at increasing HDL-C in addition to background statin therapy will further reduce risk. The AIM-HIGH (Atherothrombosis Intervention in Metabolic Syndrome With Low HDL/High Triglycerides: Impact on Global Health Outcomes) trial, which compared combined niacin/simvastatin with simvastatin alone, failed to demonstrate an incremental benefit of niacin among patients with atherosclerotic CVD and on-treatment low-density lipoprotein cholesterol values <70 mg/dl, but this study had some limitations. Previously, small randomized, clinical trials of niacin plus statins showed that modest regression of carotid atherosclerosis is possible in individuals with CVD, CVD risk equivalents, or atherosclerosis. This viewpoint summarizes these imaging trials studying niacin and places them in the context of the failure of AIM-HIGH to support the HDL-C-increasing hypothesis.

5 Review Evidence-based use of statins for primary prevention of cardiovascular disease. 2012

Minder, C Michael / Blaha, Michael J / Horne, Aaron / Michos, Erin D / Kaul, Sanjay / Blumenthal, Roger S. ·The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA. ·Am J Med · Pubmed #22387091.

ABSTRACT: Three-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors, commonly known as statins, are widely available, inexpensive, and represent a potent therapy for treating elevated cholesterol. Current national guidelines put forth by the Adult Treatment Panel III recommend statins as part of a comprehensive primary prevention strategy for patients with elevated low-density lipoprotein cholesterol at increased risk for developing coronary heart disease within 10 years. Lack of a clear-cut mortality benefit in primary prevention has caused some to question the use of statins for patients without known coronary heart disease. On review of the literature, we conclude that current data support only a modest mortality benefit for statin primary prevention when assessed in the short term (<5 years). Of note, statin primary prevention results in a significant decrease in cardiovascular morbidity over the short and long term and a trend toward increased reduction in mortality over the long term. When appraised together, these data provide compelling evidence to support the use of statins for primary prevention in patients with risk factors for developing coronary heart disease over the next 10 years.

6 Article Relationship between TSH Levels and the Advanced Lipoprotein Profile in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). 2020

José F Peixoto de Miranda, Érique / Goulart, Alessandra C / Sommer Bittencourt, Márcio / Santos, Raul D / Blaha, Michael J / Jones, Steven / Toth, Peter P / Kulkarni, Krishnaji / Santos, Itamar S / Lotufo, Paulo A / Bensenor, Isabela M. ·Department of Internal Medicine, Hospital Universitário, Universidade de Sao Paulo, Sao Paulo, Brazil. · Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo, Sao Paulo, Brazil. · Medical School Hospital, Lipid Clinic Heart Institute (InCor) Universidade Sao Paulo, Sao Paulo, Brazil. · Johns Hopkins,Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA. · Department of Preventive Cardiology, CGH Medical Center, Sterling, IL, USA. · VAP Diagnostics R & D Laboratory, Birmingham, AL, EUA. ·Endocr Res · Pubmed #32019383.

ABSTRACT:

7 Article Persistent socioeconomic disparities in cardiovascular risk factors and health in the United States: Medical Expenditure Panel Survey 2002-2013. 2018

Valero-Elizondo, Javier / Hong, Jonathan C / Spatz, Erica S / Salami, Joseph A / Desai, Nihar R / Rana, Jamal S / Khera, Rohan / Virani, Salim S / Blankstein, Ron / Blaha, Michael J / Nasir, Khurram. ·Tecnologico de Monterrey, Catedra de Cardiología y Medicina Vascular, Nuevo Leon, Mexico; Center for Healthcare Advancement and Outcomes, Baptist Health South Florida, Miami, FL, USA. · Division of Cardiac Surgery, University of British Columbia, Vancouver, BC, Canada. · Center for Outcomes Research and Evaluation, Yale New Haven Hospital, Yale University, New Haven, CT, USA. · Center for Healthcare Advancement and Outcomes, Baptist Health South Florida, Miami, FL, USA. · Division of Cardiology and Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA. · Division of Cardiology, UT Southwestern Medical Center, Dallas, TX, USA. · Michael E. DeBakey VA Medical Center & Section of Cardiovascular Research, Baylor College of Medicine, Houston, TX, USA. · Cardiovascular Imaging Program, Department of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital, Boston, MA, USA. · The Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, MD, USA. · Center for Healthcare Advancement and Outcomes, Baptist Health South Florida, Miami, FL, USA; The Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, MD, USA; Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, FL, USA; Department of Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA; Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, USA. Electronic address: KhurramN@baptisthealth.net. ·Atherosclerosis · Pubmed #29254694.

ABSTRACT: BACKGROUND AND AIMS: Socioeconomic status (SES) has been linked to worse cardiovascular risk factor (CRF) profiles and higher rates of cardiovascular disease (CVD), with an especially high burden of disease for low-income groups. We aimed to describe the trends in prevalence of CRFs among US adults by SES from 2002 to 2013. METHODS: Data from the Medical Expenditure Panel Survey was analyzed. CRFs (obesity, diabetes, hypertension, physical inactivity, smoking and hypercholesterolemia), were ascertained by ICD-9-CM and/or self-report. RESULTS: The proportion of individuals with obesity, diabetes and hypertension increased overall, with low-income groups representing a higher prevalence for each CRF. Of note, physical inactivity had the highest prevalence increase, with the "lowest-income" group observing a relative percent increase of 71.1%. CONCLUSIONS: Disparities in CRF burden continue to increase, across SES groups. Strategies to potentially eliminate the persistent health disparities gap may include a shift to greater coverage for prevention, and efforts to engage in healthy lifestyle behaviors.

8 Article Economic Impact of Moderate-Vigorous Physical Activity Among Those With and Without Established Cardiovascular Disease: 2012 Medical Expenditure Panel Survey. 2016

Valero-Elizondo, Javier / Salami, Joseph A / Osondu, Chukwuemeka U / Ogunmoroti, Oluseye / Arrieta, Alejandro / Spatz, Erica S / Younus, Adnan / Rana, Jamal S / Virani, Salim S / Blankstein, Ron / Blaha, Michael J / Veledar, Emir / Nasir, Khurram. ·Center for Healthcare Advancement and Outcomes, Baptist Health South Florida, Miami, FL. · Center for Healthcare Advancement and Outcomes, Baptist Health South Florida, Miami, FL Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, FL. · Department of Health Policy and Management, Robert Stempel College of Public Health, Florida International University, Miami, FL. · Section of Cardiovascular Medicine, Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, Yale University, New Haven, CT. · Division of Cardiology and Division of Research, Kaiser Permanente Northern California, Oakland, CA Department of Medicine, University of California San Francisco, San Francisco, CA. · Section of Cardiology, Baylor College of Medicine, Houston, TX. · Non-Invasive Cardiovascular Imaging Program, Department of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital, Boston, MA. · The Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, MD. · Center for Healthcare Advancement and Outcomes, Baptist Health South Florida, Miami, FL Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, FL Department of Medicine, School of Medicine, Emory University, Atlanta, GA. · Center for Healthcare Advancement and Outcomes, Baptist Health South Florida, Miami, FL Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, FL Department of Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL The Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, MD khurramn@baptisthealth.net. ·J Am Heart Assoc · Pubmed #27604455.

ABSTRACT: BACKGROUND: Physical activity (PA) has an established favorable impact on cardiovascular disease (CVD) outcomes and quality of life. In this study, we aimed to estimate the economic effect of moderate-vigorous PA on medical expenditures and utilization from a nationally representative cohort with and without CVD. METHODS AND RESULTS: The 2012 Medical Expenditure Panel Survey data were analyzed. Our study population was limited to noninstitutionalized US adults ≥18 years of age. Variables of interest included CVD (coronary artery disease, stroke, heart failure, dysrhythmias, or peripheral artery disease) and cardiovascular modifiable risk factors (CRFs; hypertension, diabetes mellitus, hypercholesterolemia, smoking, and/or obesity). Two-part econometric models were utilized to study cost data; a generalized linear model with gamma distribution and link log was used to assess expenditures per capita. The final study sample included 26 239 surveyed individuals. Overall, 47% engaged in moderate-vigorous PA ≥30 minutes, ≥5 days/week, translating to 111.5 million adults in the United States stratifying by CVD status; 32% reported moderate-vigorous PA among those with CVD versus 49% without CVD. Generally, participants reporting moderate-vigorous PA incurred significantly lower health care expenditures and resource utilization, displaying a step-wise lower total annual health care expenditure as moving from CVD to non-CVD (and each CRF category). CONCLUSIONS: Moderate-vigorous PA ≥30 minutes, ≥5 days/week is associated with significantly lower health care spending and resource utilization among individuals with and without established CVD.

9 Article Predicted vs Observed Clinical Event Risk for Cardiovascular Disease. 2015

DeFilippis, Andrew P / Blaha, Michael J. ·University of Louisville, Louisville, Kentucky. · Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland. ·JAMA · Pubmed #26575067.

ABSTRACT: -- No abstract --

10 Article Remnant Lipoprotein Cholesterol and Mortality After Acute Myocardial Infarction: Further Evidence for a Hypercholesterolemia Paradox From the TRIUMPH Registry. 2015

Martin, Seth S / Faridi, Kamil F / Joshi, Parag H / Blaha, Michael J / Kulkarni, Krishnaji R / Khokhar, Arif A / Maddox, Thomas M / Havranek, Edward P / Toth, Peter P / Tang, Fengming / Spertus, John A / Jones, Steven R. ·Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland. · Atherotech Diagnostics Laboratory, Birmingham, Alabama. · Northwest London Hospitals NHS Trust, London, United Kingdom. · VA Eastern Colorado Health Care System, Denver, Colorado. · University of Colorado School of Medicine, Aurora, Colorado. · Department of Preventive Cardiology, CGH Medical Center, Sterling, Illinois. · University of Illinois School of Medicine, Peoria, Illinois. · Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri. ·Clin Cardiol · Pubmed #26459191.

ABSTRACT: BACKGROUND: Remnants are partially hydrolyzed, triglyceride-rich lipoproteins that, like other apolipoprotein B-containing lipoproteins, are atherogenic. Prior observational studies suggest paradoxically better outcomes in hypercholesterolemic patients who sustain an acute myocardial infarction (AMI), one of several known recurrent risk paradoxes. To date, the association of directly measured remnant lipoprotein cholesterol (RLP-C) with survival after an AMI has not been examined. HYPOTHESIS: Higher RLP-C levels may be paradoxically associated with lower mortality. METHODS: We examined 2465 AMI survivors in a prospective, 24-center US study of AMI outcomes. Lipoprotein cholesterol subfractions were directly measured by ultracentrifugation. RLP-C was defined as intermediate-density lipoprotein cholesterol (IDL-C) + very-low-density lipoprotein cholesterol subfraction 3 (VLDL3 -C). Given a linear relationship between RLP-C and mortality, we examined RLP-C by tertiles and continuously. Cox regression hazard ratios (HRs) were adjusted for the Global Registry of Acute Coronary Events (GRACE) score and 23 other covariates. RESULTS: Participants were age 58 ± 12 years (mean ± SD), and 68% were men. After 2 years of follow-up, 226 (9%) participants died. The mortality proportion was 12.4% in the lowest tertile of RLP-C (0-15 mg/dL), 8.5% in the middle tertile (16-23 mg/dL), and 6.8% in the highest tertile (24-120 mg/dL; P < 0.001). A 1-SD increase in RLP-C (11 mg/dL) predicted a 24% lower adjusted risk of 2-year mortality (HR: 0.76, 95% confidence interval [CI]: 0.64-0.91). Similar results were found for a 1-SD increase in IDL-C (HR per 8 mg/dL: 0.80, 95% CI: 0.67-0.96), VLDL3 -C (HR per 4 mg/dL: 0.74, 95% CI: 0.61-0.89), and very-low-density lipoprotein cholesterol (VLDL-C; HR per 8 mg/dL: 0.69, 95% CI: 0.55-0.85). CONCLUSIONS: Higher RLP-C levels were associated with lower mortality 2 years after AMI despite rigorous adjustment for known confounders. Unknown protective factors or a lead-time bias likely explains the paradox.

11 Article Screening and advanced lipid phenotyping in familial hypercholesterolemia: The Very Large Database of Lipids Study-17 (VLDL-17). 2015

Miller, P Elliott / Martin, Seth S / Toth, Peter P / Santos, Raul D / Blaha, Michael J / Nasir, Khurram / Virani, Salim S / Post, Wendy S / Blumenthal, Roger S / Jones, Steven R. ·Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA. Electronic address: elliottmiller@jhmi.edu. · Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA. · Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA; Department of Preventive Cardiology, CGH Medical Center, Sterling, IL, USA; University of Illinois College of Medicine, Peoria, IL, USA. · Lipid Clinic Heart Institute, Preventive Medicine Center Hospital Israelita Albert Einstein, InCor University of São Paulo Medical School Hospital, Sao Paulo, Brazil. · Center for Prevention & Wellness Research, Baptist Health Medical Group, Miami, FL, USA. · Section of Cardiovascular Research, Michael E. DeBakey Veterans Affairs Medical Center, Baylor College of Medicine, Houston, TX, USA. ·J Clin Lipidol · Pubmed #26350814.

ABSTRACT: BACKGROUND: Familial hypercholesterolemia (FH) is an autosomal dominant dyslipidemia characterized by defective low-density lipoprotein (LDL) clearance. The aim of this study was to compare Friedewald-estimated LDL cholesterol (LDL-C) to biologic LDL-C in individuals screening positive for FH and then further characterize FH phenotypes. METHODS: We studied 1,320,581 individuals from the Very Large Database of Lipids, referred from 2009 to 2011 for Vertical Auto Profile ultracentrifugation testing. Friedewald LDL-C was defined as the cholesterol content of LDL-C, intermediate-density lipoprotein cholesterol, and lipoprotein(a) cholesterol (Lp(a)-C), with LDL-C representing biologic LDL-C. Using Friedewald LDL-C, we phenotypically categorized patients by the National Lipid Association guideline age-based screening thresholds for FH. In those meeting criteria, we categorized patients using population percentile-equivalent biologic LDL-C cutpoints and explored Lp(a)-C and remnant lipoprotein cholesterol (RLP-C) levels. RESULTS: Overall, 3829 patients met phenotypic criteria for FH by Friedewald LDL-C screening (FH+). Of those screening FH+, 78.8% were above and 21.2% were below the population percentile-equivalent biologic LDL-C. The mean difference in Friedewald biologic LDL-C percentiles was -0.01 (standard deviation, 0.17) for those above, and 1.92 (standard deviation, 9.16) for those below, respectively. Over 1 of 3 were found to have an elevated Lp(a)-C and over 50% had RLP-C greater than 95th percentile of the entire VLDL population. CONCLUSIONS: Of those who screened FH+, Friedewald and biologic LDL-C levels were closely correlated. Large proportions of the FH+ group had excess levels of Lp(a)-C and RLP-C. Future studies are warranted to study these mixed phenotypic groups and determine the role for further risk stratification and treatment algorithms.

12 Article Comparison of a novel method vs the Friedewald equation for estimating low-density lipoprotein cholesterol levels from the standard lipid profile. 2013

Martin, Seth S / Blaha, Michael J / Elshazly, Mohamed B / Toth, Peter P / Kwiterovich, Peter O / Blumenthal, Roger S / Jones, Steven R. ·Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland. ·JAMA · Pubmed #24240933.

ABSTRACT: IMPORTANCE: In clinical and research settings worldwide, low-density lipoprotein cholesterol (LDL-C) is typically estimated using the Friedewald equation. This equation assumes a fixed factor of 5 for the ratio of triglycerides to very low-density lipoprotein cholesterol (TG:VLDL-C); however, the actual TG:VLDL-C ratio varies significantly across the range of triglyceride and cholesterol levels. OBJECTIVE: To derive and validate a more accurate method for LDL-C estimation from the standard lipid profile using an adjustable factor for the TG:VLDL-C ratio. DESIGN, SETTING, AND PARTICIPANTS: We used a convenience sample of consecutive clinical lipid profiles obtained from 2009 through 2011 from 1,350,908 children, adolescents, and adults in the United States. Cholesterol concentrations were directly measured after vertical spin density-gradient ultracentrifugation, and triglycerides were directly measured. Lipid distributions closely matched the population-based National Health and Nutrition Examination Survey (NHANES). Samples were randomly assigned to derivation (n = 900,605) and validation (n = 450,303) data sets. MAIN OUTCOMES AND MEASURES: Individual patient-level concordance in clinical practice guideline LDL-C risk classification using estimated vs directly measured LDL-C (LDL-CD). RESULTS: In the derivation data set, the median TG:VLDL-C was 5.2 (IQR, 4.5-6.0). The triglyceride and non-high-density lipoprotein cholesterol (HDL-C) levels explained 65% of the variance in the TG:VLDL-C ratio. Based on strata of triglyceride and non-HDL-C values, a 180-cell table of median TG:VLDL-C values was derived and applied in the validation data set to estimate the novel LDL-C (LDL-CN). For patients with triglycerides lower than 400 mg/dL, overall concordance in guideline risk classification with LDL-CD was 91.7% (95% CI, 91.6%-91.8%) for LDL-CN vs 85.4% (95% CI, 85.3%-85.5%) for Friedewald LDL-C (LDL-CF) (P < .001). The greatest improvement in concordance occurred in classifying LDL-C lower than 70 mg/dL, especially in patients with high triglyceride levels. In patients with an estimated LDL-C lower than 70 mg/dL, LDL-CD was also lower than 70 mg/dL in 94.3% (95% CI, 93.9%-94.7%) for LDL-CN vs 79.9% (95% CI, 79.3%-80.4%) for LDL-CF in samples with triglyceride levels of 100 to 149 mg/dL; 92.4% (95% CI, 91.7%-93.1%) for LDL-CN vs 61.3% (95% CI, 60.3%-62.3%) for LDL-CF in samples with triglyceride levels of 150 to 199 mg/dL; and 84.0% (95% CI, 82.9%-85.1%) for LDL-CN vs 40.3% (95% CI, 39.4%-41.3%) for LDL-CF in samples with triglyceride levels of 200 to 399 mg/dL (P < .001 for each comparison). CONCLUSIONS AND RELEVANCE: A novel method to estimate LDL-C using an adjustable factor for the TG:VLDL-C ratio provided more accurate guideline risk classification than the Friedewald equation. These findings require external validation, as well as assessment of their clinical importance. The implementation of these findings into clinical practice would be straightforward and at virtually no cost. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01698489.

13 Article Statin therapy for healthy men identified as "increased risk". 2012

Blaha, Michael J / Nasir, Khurram / Blumenthal, Roger S. ·The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, 600 N Wolfe St, Baltimore, MD 21287, USA. ·JAMA · Pubmed #22496260.

ABSTRACT: -- No abstract --

14 Minor Statin therapy for hyperlipidemia. 2013

McEvoy, John W / Blumenthal, Roger S / Blaha, Michael J. · ·JAMA · Pubmed #24045746.

ABSTRACT: -- No abstract --