Non-High-Density Lipoprotein
Abstract & Commentary
By Michael H. Crawford, MD, Professor of Medicine, and Chief of Clinical Cardiology, at the University of California, San Francisco. Dr. Crawford is on the speaker's bureau for Pfizer.
Synopsis: In the Framingham study non-HDL cholesterol is a stonger predictor of subsequent CHD than LDL cholesterol.
Source: Liu J, et al. Non-High-Density Lipoprotein and Very-Low-Density Lipoprotein Cholesterol and Their Risk Predictive Values in Coronary Heart Disease. Am J Cardiol. 2006;98:1363-1368.
The predictive value of non-high-density lipoprotein (HDL) cholesterol for coronary heart disease (CHD) is unclear. Thus, Liu and colleagues evaluated the original Framingham Cohort Study and the Framingham Offspring Study to assess the contribution of non-HDL cholesterol as compared to low-density lipoprotein (LDL) cholesterol for predicting CHD and whether very low-density lipoprotein (VLDL), a major component of non-HDL cholesterol, is an independent predictor of CHD. Total cholesterol, HDL cholesterol, and triglycerides were measured directly; LDL and VLDL were estimated using standard methods (Lipid Research Clinics). Non-HDL cholesterol was the difference between total cholesterol and HDL cholesterol. The CHD end point was cardiovascular death, myocardial infarction, or acute coronary insufficiency. Results: during an average 15-year follow-up of 5,794 subjects, there were 990 CHD events (107/10,000 subject-years). All lipid parameters showed a strong graded correlation with CHD. When non-HDL cholesterol levels were divided into groups, LDL cholesterol did not contribute to the risk prediction. When the converse was done, non-HDL cholesterol showed a strong, positive association with CHD risk in every LDL level group. Thus, non-HDL cholesterol seems to be a better predictor of CHD risk as compared to LDL cholesterol. Triglyceride levels did not influence these results. VLDL cholesterol was also found to be a significant predictor of risk after adjusting for triglyceride and LDL levels. The authors concluded that non-HDL cholesterol is a stronger predictor of CHD risk than LDL cholesterol and VLDL cholesterol is an independent predictor of CHD.
Commentary
Since the Adult Treatment Panel III identified non-HDL cholesterol as a secondary goal in lipid management, especially in those with increased triglycerides, most labs have included this number in their lipid panel. Non-HDL cholesterol is the difference between total cholesterol and HDL cholesterol, and is made up mostly of LDL and VLDL cholesterol, but also may contain triglyceride rich lipoproteins and remnant lipoproteins. The results of this analysis show that non-HDL cholesterol is a better predictor than LDL cholesterol of future CHD and that VLDL is also an independent predictor of CHD. Does this mean that we abandon LDL cholesterol as a target and focus on non-HDL cholesterol? Not necessarily; LDL is still an independent predictor of CHD risk and there are considerable data supporting its utility as a goal for therapy. However, non-HDL cholesterol should be considered also, especially in the patient with a low LDL. The typical patient with a high non-HDL cholesterol level is a man with diabetes and hypertension who has a moderate elevation of triglycerides, increased small, dense LDL particles and a low HDL. Targets for non-HDL cholesterol run about 30 mg/dl higher than LDL target levels to account for the VLDL fraction. For example, a clinical indication to get LDL < 130, non-HDL should be < 160 mg/dl.
In the Framingham study non-HDL cholesterol is a stonger predictor of subsequent CHD than LDL cholesterol.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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