title: Discordance between non-HDL-cholesterol and LDL-particle measurements: results from the Multi-Ethnic Study of Atherosclerosis.
abstract: BACKGROUND
  Cardiovascular risk assessment incorporates measurement of atherogenic lipids such as non-HDL cholesterol (non-HDL-C). It remains uncertain under which circumstances atherogenic lipoprotein enumeration such as LDL particle number (LDL-P) differs from simultaneously acquired non-HDL-C.
  
  
  METHODS
  Participants of the Multi-Ethnic Study of Atherosclerosis (MESA) were deemed LDL-P > non-HDL-C discordant if they exhibited higher LDL-P than expected for simultaneously measured non-HDL-C, given the observed distribution of both in MESA. Conversely, a lower LDL-P than would be suggested from non-HDL-C characterized LDL-P < non-HDL-C discordance. Regression models were used to estimate associations of demographics and comorbidities with discordance and of LDL-P and non-HDL-C with carotid intima-media thickness (CIMT) and detectable coronary artery calcium (CAC) among discordance groups.
  
  
  RESULTS
  Discordance was observed among 44% of subjects. LDL-P > non-HDL-C compared to LDL-P < non-HDL-C discordance was more common among Hispanics and smokers; among subjects with lower HDL-C, lower triglycerides, or greater insulin resistance by homeostatic model assessment of insulin resistance (HOMA-IR); and among subjects on lipid-lowering therapy, anti-hypertensive therapy, or hormone replacement therapy. In the setting of discordance, LDL-P exhibited a modestly greater association with CIMT than did non-HDL-C (+0.024-0.025 mm vs +0.018-0.021 mm per SD increase). In the presence of LDL-P < non-HDL-C discordance, LDL-P demonstrated a modestly greater association with detectable CAC than did non-HDL-C (OR 1.51 vs 1.46 per SD increase).
  
  
  CONCLUSIONS
  Our results demonstrated that disagreement between LDL-P and non-HDL-C was common and significantly associated with several clinical characteristics. In the setting of discordance, LDL-P was more closely associated with CIMT and CAC than non-HDL-C, though observed differences were small.
authors.affiliation: Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, PA, USA. Emil.deGoma@uphs.upenn.edu
authors.forename: Emil M
authors.initials: EM
authors.lastname: Degoma
authors.forename: Mat D
authors.initials: MD
authors.lastname: Davis
authors.forename: Richard L
authors.initials: RL
authors.lastname: Dunbar
authors.forename: Emile R
authors.initials: ER
authors.lastname: Mohler
authors.forename: Philip
authors.initials: P
authors.lastname: Greenland
authors.forename: Benjamin
authors.initials: B
authors.lastname: French
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D001055:Apolipoproteins B / Q000097:blood; D001213:Asian / Q000706:statistics & numerical data; D050197:Atherosclerosis / Q000188:drug therapy* / Q000208:ethnology* / Q000378:metabolism; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood*; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D057285:Precision Medicine; D011237:Predictive Value of Tests; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D044465:White People / Q000706:statistics & numerical data
chemical_list: D000924:Anticholesteremic Agents; D001055:Apolipoproteins B; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL
keywords: Apolipoprotein B; Cholesterol; LDL-particle number; Lipoproteins; Risk assessment