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Is triglycerides a better monitoring choice than LDL-C on a GLP-1 receptor agonist?

Asked 27 Jul 2024Modified 21 months agoViewed 19k times
19

For reference: triglycerides · LDL-C · a GLP-1 receptor agonist.

The comparison I want does not seem to exist anywhere in a form I can evaluate.

I have read the arguments for each and they do not engage with each other.

What does each option buy me, and what does it cost me?

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askedpieter_maas14k1727 Jul 2024
5Can you say how far out of range rather than that it was flagged? The flag is a threshold, not a finding. – kirsi_lahtinen 10 months ago
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5 Answers

Accepted answer first, then by votes
46

Accepted answer

The short version: a small, well-chosen panel with a baseline beats a large one without.

A twenty-analyte panel run on a healthy person will produce, on average, one out-of-range result purely from how reference intervals are constructed. That is arithmetic rather than pathology.

Relative to absolute, worked

QuantityValueDerivation
Control-arm event rate8.0 %From the trial table, not the abstract
Hazard ratio0.80Reported
Treated event rate6.4 %8.0 × 0.80
Absolute risk reduction1.6 pp8.0 − 6.4
Number needed to treat631 ÷ 0.016
Relative risk reduction20 %1 − 0.80

The last two rows describe the same finding. Only one of them is used in headlines.

Stated carefully, delta checks — comparing against your own previous value — are far more sensitive than comparing against a population interval, which is the argument for keeping a series rather than a snapshot.

External quality assurance schemes document between-laboratory differences on common analytes that routinely exceed the size of clinically interesting changes.

The caveat is that a panel is not a diagnosis and interpreting one is a clinician's job, particularly when several values move together.

Same laboratory, same time, same fasting state, or the comparison is not a comparison.

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answered · acceptedDr_Colm_Fitzhenry69k24714 Sept 2024
6Minor: haemolysis inflates potassium enough to cause a fright over what is a handling artefact. – siobhan_deasy 9 months ago
5This should be linked from the help pages. – plate_count_9k 8 months ago
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38

This is answerable, and the answer is mostly about which tests rather than how many.

A sensible core for this population is a full blood count, renal function with electrolytes, liver enzymes with bilirubin, a fasting lipid panel with apolipoprotein B, HbA1c and thyroid-stimulating hormone.

Timing matters per analyte: cortisol and testosterone are diurnal, triglycerides are postprandial, and creatinine responds to hydration and to recent training. Fixing the conditions removes most of the noise.

One out-of-range value on a twenty-analyte panel is expected. Two on a repeat is a finding.

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answeredDr_Ravi_Selvarajah35k13725 Sept 2024
Thank you — this is the answer I was looking for. – ines_brandt 3 months ago
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17

Answer first: decide what you would do differently for each possible result before you order the panel. Anything that fails that test is a number you will worry about and not act on.

Repeat before you react. A single abnormal value has a substantial probability of being within the combined biological and analytical variation of a normal one.

More usefully, same laboratory, same method, same time of day, same fasting state. Between-laboratory differences on several common analytes are larger than the changes people are trying to detect.

Pre-analytical factors — posture, tourniquet time, fasting, sample handling — are the largest source of error in routine biochemistry, well ahead of the analysis itself.

Ordering tests you will not act on generates anxiety and incidental findings, both of which have costs.

Keep the full report, not the number. You will need the units and the interval later.

edited 7 Sept 2024 by triple_agonist_q — tightened the wording; no substantive change

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answeredtriple_agonist_q57k383 Sept 2024
15

The relevant statistical point is that a ninety-five per cent reference interval means one analyte in twenty will read out of range in a healthy person by construction.

Haemolysis in the sample raises potassium and several enzymes spuriously. If a result is bizarre, ask whether the sample was flagged before building a theory on it.

Nothing here is medical advice. If something is out of range and you do not know why, that is a consultation rather than a research project.

Decide the action for each result before you order the test.

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answeredDr_Rosalind_Achebe69k14723 Aug 2024
11

The honest position is that most people order too many analytes and too few time points, when the reverse would be more informative.

Keep the reports rather than the numbers. Units, reference intervals and methods all vary, and a bare number two years later is not comparable to anything.

Reference intervals are conventionally the central ninety-five per cent of a reference population, which is the direct cause of the one-in-twenty out-of-range rate on a healthy panel.

Baseline first, then a repeat under identical conditions. Everything else is secondary.

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answeredDr_Sara_Kuusela28k379 Nov 2024
7Does this hold for a non-fasting draw, or does the triglyceride figure make that a different conversation? – petra_hovland 4 months ago
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