Modern prevalence of dysbetalipoproteinemia (fredrickson-levy-lees type III hyperlipoproteinemia)

Vincent A. Pallazola, Vasanth Sathiyakumar, Jihwan Park, Rachit M. Vakil, Peter P. Toth, Mariana Lazo-Elizondo, Emily Brown, Renato Quispe, Eliseo Guallar, Maciej Banach, Roger S. Blumenthal, Steven R. Jones, David Marais, Daniel Soffer, Allan D. Sniderman, Seth S. Martin

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Introduction: 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. Material and methods: 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. Results: 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 p < 0.001) than those who were apoB method positive and UC criteria 1 negative. Conclusions: 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.

Original languageEnglish (US)
Pages (from-to)993-1003
Number of pages11
JournalArchives of Medical Science
Issue number5
StatePublished - Aug 2 2019


  • Apolipoprotein B
  • Dysbetalipoproteinemia
  • National Health and Nutrition Examination Survey
  • Type III hyperlipoproteinemia
  • Very Large Database of Lipids (VLDL)

ASJC Scopus subject areas

  • Medicine(all)


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