The role of non-HDL cholesterol in risk stratification for coronary artery disease.
Despite aggressive lipid-lowering therapy, patients continue to be at significant risk of coronary heart disease (CHD). Assessment of non-high-density lipoprotein cholesterol (non-HDL-C) provides a measure of cholesterol contained in all atherogenic particles. In the third Adult Treatment Panel (ATP III) guidelines of the US National Cholesterol Education Program, non-HDL-C was introduced as a secondary target of therapy in persons with triglycerides ≥200 mg/dL. A recent meta-analysis of the relationship between non-HDL-C reduction and CHD risk showed non-HDL-C as an important target of therapy for CHD prevention. Most lipid-modifying drugs used as monotherapy have a 1:1 relationship between percent non-HDL-C lowering and percent CHD reduction. In the EPIC-Norfolk prospective population study, 21,448 participants without diabetes or CHD between 45 and 79 years of age were followed for 11.0 years. Participants with high non-HDL-C levels were at increased CHD risk independently of their LDL-C levels. Also, compared to apolipoprotein B, non-HDL-C appears to be a better choice given the fact that no additional tests or costs are needed and established cut points are already available. Future guidelines should emphasize the importance of non-HDL-C for guiding cardiovascular prevention strategies with an increased need to have non-HDL-C reported on routine lipid panels.
Division of Cardiology and Oppenheimer Atherosclerosis Research Center, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA. jamal.rana@cshs.org
Jamal S
JS
Rana
S Matthijs
SM
Boekholdt
John J P
JJ
Kastelein
Prediman K
PK
Shah
D000328:Adult; D000368:Aged; D001055:Apolipoproteins B / Q000187:drug effects / Q000378:metabolism*; D008076:Cholesterol, HDL / Q000187:drug effects / Q000378:metabolism*; D008078:Cholesterol, LDL / Q000187:drug effects / Q000378:metabolism*; D003324:Coronary Artery Disease / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D005260:Female; D006801:Humans; D006937:Hypercholesterolemia / Q000150:complications / Q000188:drug therapy / Q000401:mortality; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome
D001055:Apolipoproteins B; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D000960:Hypolipidemic Agents