Discordance Between Apolipoprotein B (apoB) and LDL-Cholesterol (LDL-C) and Incident Hypertension Risk among Patients with and without Type 2 Diabetes (T2D): An Analysis of US Real-World Data
Moderator
Janna Manjelievskaia, MPH, PhD, Veradigm Life Sciences, Raleigh, NC, United States
Speakers
Ni Zeng; Joana Tome; Kevin Lavelle; Auren Weinberg; Maryam Ajose; Elizabeth Marchlewicz
OBJECTIVES: Discordance between apolipoprotein B (apoB) and LDL cholesterol (LDL-C) values has been reported in ~20% of US adults. Recommended in the National Lipid Association guidelines for routine lipid screening inclusion, apoB may be superior to LDL-C in risk assessment. Levels of lipid discordance and subsequent cardiovascular-related risk among T2D patients are unknown.
METHODS: This retrospective cohort study identified adults in the Veradigm Network EHR linked to claims with an apoB and LDL-C lab result within 6 months of each other between 2013-2023 (earliest lab=index). Patients were required to have EHR/claims activity ≥12 months pre- and ≥24 months post-index. Cohorts were stratified by no evidence of T2D during the study period and those with a baseline T2D diagnosis. Based on median values, discordance categories were examined within cohorts. Demographics and clinical characteristics (including medication use) were assessed during baseline and cardiovascular event frequencies, including incident hypertension, were reported during follow-up. Multivariable logistic regression was used to examine incident hypertension odds and risk among each cohort.
RESULTS: Of the 2,475 with and 5,907 adults without T2D included, about 21% were apoB/LDL-C discordant. ASCVD risk score was highest among T2D (18-23%). Majority of T2D patients were on a lipid-lowering therapy at baseline (68%) vs without T2D (35%). Discordant high-risk patients without T2D had higher odds of developing incident hypertension (OR: 1.63, 95% CI: 1.1-2.4). Odds for discordant high-risk T2D patients trended toward higher risk (OR: 1.99, 95% CI: 0.9-4.2), though 41% of T2D patients developed incident hypertension compared to 18% of those without T2D.
CONCLUSIONS: Among patients without T2D, apoB can serve as an important metric in predicting hypertension development when LDL-C values are within normal range. T2D serves as an independent risk factor for hypertension. Substantial levels of discordance in these populations indicate a need for improved rates of apoB testing in lipid management.
METHODS: This retrospective cohort study identified adults in the Veradigm Network EHR linked to claims with an apoB and LDL-C lab result within 6 months of each other between 2013-2023 (earliest lab=index). Patients were required to have EHR/claims activity ≥12 months pre- and ≥24 months post-index. Cohorts were stratified by no evidence of T2D during the study period and those with a baseline T2D diagnosis. Based on median values, discordance categories were examined within cohorts. Demographics and clinical characteristics (including medication use) were assessed during baseline and cardiovascular event frequencies, including incident hypertension, were reported during follow-up. Multivariable logistic regression was used to examine incident hypertension odds and risk among each cohort.
RESULTS: Of the 2,475 with and 5,907 adults without T2D included, about 21% were apoB/LDL-C discordant. ASCVD risk score was highest among T2D (18-23%). Majority of T2D patients were on a lipid-lowering therapy at baseline (68%) vs without T2D (35%). Discordant high-risk patients without T2D had higher odds of developing incident hypertension (OR: 1.63, 95% CI: 1.1-2.4). Odds for discordant high-risk T2D patients trended toward higher risk (OR: 1.99, 95% CI: 0.9-4.2), though 41% of T2D patients developed incident hypertension compared to 18% of those without T2D.
CONCLUSIONS: Among patients without T2D, apoB can serve as an important metric in predicting hypertension development when LDL-C values are within normal range. T2D serves as an independent risk factor for hypertension. Substantial levels of discordance in these populations indicate a need for improved rates of apoB testing in lipid management.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
CO64
Topic
Clinical Outcomes
Topic Subcategory
Clinical Outcomes Assessment
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory)