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ISSN: 1734-1922
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6/2020
vol. 16
 
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Lipid disorders
abstract:
Clinical research

Modern prevalence of the Fredrickson-Levy-Lees dyslipidemias: findings from the Very Large Database of Lipids and National Health and Nutrition Examination Survey

Vasanth Sathiyakumar
1
,
Vincent A. Pallazola
1
,
Jihwan Park
2
,
Rachit M. Vakil
1
,
Peter P. Toth
1, 3
,
Mariana Lazo-Elizondo
2, 4
,
Renato Quispe
1, 4
,
Eliseo Guallar
2, 4
,
Maciej Banach
5
,
Roger S. Blumenthal
1
,
Steven R. Jones
1
,
Seth S. Martin
1, 4

1.
Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
2.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
3.
Department of Medicine, Community Hospital General Medical Center, Sterling, IL, USA
4.
Welch Center for Prevention, Epidemiology, and Clinical Research, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
5.
Cardiovascular Research Centre, University of Zielona Gora, Zielona Gora, Poland
Arch Med Sci 2020; 16 (6): 1279–1287
Online publish date: 2019/08/03
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Introduction
Five decades ago, Fredrickson, Levy, and Lees (FLL) qualitatively characterized clinical dyslipidemias with specific implications for cardiovascular and non-cardiovascular morbidity and mortality. They separated disorders of elevated cholesterol and triglycerides into five phenotypes (types I–V) based on their lipoprotein profile. Although clinicians generally consider them rare entities, modern FLL prevalence may be greater than previously reported.

Material and methods
We performed a cross-sectional analysis in 5,272 participants from the 2011–2014 National Health and Nutrition Examination Survey and 128,506 participants from the Very Large Database of Lipids study with complete, fasting lipid profiles. We used a validated algorithm to define FLL phenotypes employing apolipoprotein B, total cholesterol, and triglycerides.

Results
Overall prevalence of FLL phenotypes was 33.9%. FLL prevalence in the general population versus clinical lipid database was: type I (0.05 vs. 0.02%), type IIa (3.2 vs. 3.9%), type IIb (8.0 vs. 10.3%), type III (2.0 vs. 1.7%), type IV (20.5 vs. 24.1%), and type V (0.15 vs. 0.13%). Those aged 40–74 years had a higher overall prevalence compared to other age groups (p < 0.001) and men had overall higher prevalence than women (p < 0.001). Those with diabetes (51.6%) or obese BMI (49.0%) had higher prevalence of FLL phenotypes compared to those without diabetes (31.3%; p < 0.001) and normal BMI (18.3%; p < 0.001).

Conclusions
FLL phenotypes are likely far more prevalent than appreciated in clinical practice, in part due to diabetes and obesity epidemics. Given the prognostic and therapeutic importance of these phenotypes, their identification becomes increasingly important in the era of precision medicine.

keywords:

Very Large Database of Lipids, National Health and Nutrition Examination Survey, hyperlipoproteinemia, apolipoprotein B, prevalence

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