title: Substituting non-HDL cholesterol with LDL as a guide for lipid-lowering therapy increases the number of patients with indication for therapy.
abstract: OBJECTIVE
  Our objective was to assess the number of patients with an indication for lipid-lowering therapy according to their non-HDL cholesterol (N-HDL-C) (>130 mg/dL) concentrations despite on-target LDL (≤100 mg/dL) values determined using ultracentrifugation (UC) or direct enzymatic methods (DM).
  
  
  METHODS
  In 1590 patients we studied the lipid profile using standard biochemical methods and sequential UC (N = 637) or triglyceride (TG) independent DM (N = 953). The indications for lipid-lowering therapy were compared by evaluating the real LDL concentration or N-HDL-C concentration.
  
  
  RESULTS
  The LDL/N-HDL-C correlation significantly decreased with increasing triglyceride concentrations: normal (r = 0.924, p < 0.001), 150-400 mg/dL (r = 0.825, p < 0.001) and higher than 400 mg/dL (r = 0.460, p < 0.001) (p < 0.001). The percentage of patients with an N-HDL-C concentration above the recommended level, despite having an LDL concentration that was on target, also increased significantly across the TG tertiles (3.1%, 15.6% and 57.%, respectively; p < 0.001). Of the patients with a TG level above 400 mg/dL and an LDL concentration that was on target, 86% had an N-HDL-C concentration above 130 mg/dL. Of the patients with a TG level above 400 and an N-HDL-C concentration qualifying for therapy, 40% had an LDL concentration that was on target. The ApoB concentration had a stronger concordance with the LDL concentration than N-HDL-C.
  
  
  CONCLUSIONS
  Using the N-HDL-C concentration as a therapeutic target in hypertriglyceridemic patients almost doubled the number of patients requiring treatment. The ApoB concentration had a better association with LDL when determining the need for lipid-lowering therapy.
authors.affiliation: Vascular Medicine and Metabolism Unit, Research Unit on Lipids and Atherosclerosis, Sant Joan University Hospital, Universitat Rovira i Virgili, IISPV, Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Reus, Spain. luis.masana@urv.cat
authors.forename: Luís
authors.initials: L
authors.lastname: Masana
authors.forename: Daiana
authors.initials: D
authors.lastname: Ibarretxe
authors.forename: Mercedes
authors.initials: M
authors.lastname: Heras
authors.forename: Anna
authors.initials: A
authors.lastname: Cabré
authors.forename: Raimon
authors.initials: R
authors.lastname: Ferré
authors.forename: Jordi
authors.initials: J
authors.lastname: Merino
authors.forename: Núria
authors.initials: N
authors.lastname: Plana
authors.forename: Josefa
authors.initials: J
authors.lastname: Girona
mesh_terms: D001055:Apolipoproteins B / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood*; D008078:Cholesterol, LDL / Q000097:blood*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D006949:Hyperlipidemias / Q000188:drug therapy*; D008055:Lipids / Q000097:blood; D012189:Retrospective Studies; D014280:Triglycerides / Q000097:blood; D014461:Ultracentrifugation
chemical_list: D001055:Apolipoproteins B; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008055:Lipids; D014280:Triglycerides