Biomarkers predict cardiovascular outcomes in European cohort

Le résumé fourni par la source

This commentary refers to ‘Low-density lipoprotein cholesterol, C-reactive protein, and lipoprotein(a) universal one-time screening in primary prevention: the EPIC-Norfolk study’, by J.M. Kraaijenhof et al., https://doi.org/10.1093/eurheartj/ehaf209 and the discussion piece ‘A stitch in time: easily measured biomarkers to enhance cardiovascular risk prediction in primary prevention’, by J.M. Kraaijenhof et al., https://doi.org/10.1093/eurheartj/ehaf488. We read with great interest the recent article by Jordan M. Kraaijenhof et al.,1 (European Heart Journal. 2025; ehaf209), which highlights that a single one-time simultaneous evaluation of LDL cholesterol, hsCRP, and Lp(a) predicts cardiovascular risk over a subsequent 20-year period.1 While we commend the authors for their comprehensive analysis, several limitations warrant discussion to guide future research and clinical practice, we would like to raise several critical points for further discussion. Firstly, the study employed the Friedewald equation to estimate LDL-C from non-fasting samples. LDL-C was measured with a direct-measurement assay in the American cohort.2 While this approach is convenient, it relies on the assumption that triglycerides (TG) are distributed proportionally across lipoprotein subfractions—a limitation particularly evident in non-fasting states or when TG exceeds 4.5 mmol/L. Notably, the authors did not report the distribution of baseline TG levels or validate the Friedewald formula against direct LDL-C measurements. This omission is concerning because non-fasting hypertriglyceridaemia, common in insulin-resistant populations, can lead to systematic underestimation of LDL-C, potentially misclassifying individuals at high atherogenic risk. Report TG distribution and assess the concordance between Friedewald-estimated and directly measured LDL-C to improve accuracy.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.