title: Patient-Level Discordance in Population Percentiles of the Total Cholesterol to High-Density Lipoprotein Cholesterol Ratio in Comparison With Low-Density Lipoprotein Cholesterol and Non-High-Density Lipoprotein Cholesterol: The Very Large Database of Lipids Study (VLDL-2B).
abstract: BACKGROUND
  The total cholesterol to high-density lipoprotein cholesterol (TC/HDL-C) ratio, estimated low-density lipoprotein cholesterol (LDL-C), and non-HDL-C are routinely available from the standard lipid profile. We aimed to assess the extent of patient-level discordance of TC/HDL-C with LDL-C and non-HDL-C, because discordance suggests the possibility of additional information.
  
  
  RESULTS
  We compared population percentiles of TC/HDL-C, Friedewald-estimated LDL-C, and non-HDL-C in 1 310 432 US adults from the Very Large Database of Lipids. Lipid testing was performed by ultracentrifugation (Vertical Auto Profile, Atherotech, AL). One in 3 patients had ≥25 percentile units discordance between TC/HDL-C and LDL-C, whereas 1 in 4 had ≥25 percentile units discordance between TC/HDL-C and non-HDL-C. The proportion of patients with TC/HDL-C > LDL-C by ≥25 percentile units increased from 3% at triglycerides <100 mg/dL to 51% at triglycerides 200 to 399 mg/dL. On a smaller scale, TC/HDL-C > non-HDL-C discordance by ≥25 percentile units increased from 6% to 21%. In those with <15th percentile levels of LDL-C (<70 mg/dL) or non-HDL-C (<93 mg/dL), a respective 58% and 46% were above the percentile-equivalent TC/HDL-C of 2.6. Age, sex, and directly measured components of the standard lipid profile explained >86% of the variance in percentile discordance between TC/HDL-C versus LDL-C and non-HDL-C.
  
  
  CONCLUSIONS
  In this contemporary, cross-sectional, big data analysis of US adults who underwent advanced lipid testing, the extent of patient-level discordance suggests that TC/HDL-C may offer potential additional information to LDL-C and non-HDL-C. Future studies are required to determine the clinical implications of this observation.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT01698489.
authors.affiliation: From Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (M.B.E., R.Q.,E.D.M., P.P.T., R.S.B., S.R.J., S.S.M.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (M.B.E.); Welch Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (E.D.M., J.C., S.S.M.); Mike Rosenbloom Laboratory for Cardiovascular Research, McGill University Health Centre, Montreal, Quebec, Canada (A.D.S.); Department of Preventive Cardiology, CGH Medical Center, Sterling, IL, and University of Illinois College of Medicine, Peoria (P.P.T.); Department of Hypertension, Medical University of Lodz, Poland (M.B.); and Atherotech Diagnostics Laboratory, Birmingham, AL (K.R.K.). elshazm@ccf.org mes2015@qatar-med.cornell.edu.
authors.forename: Mohamed B
authors.initials: MB
authors.lastname: Elshazly
authors.affiliation: From Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (M.B.E., R.Q.,E.D.M., P.P.T., R.S.B., S.R.J., S.S.M.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (M.B.E.); Welch Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (E.D.M., J.C., S.S.M.); Mike Rosenbloom Laboratory for Cardiovascular Research, McGill University Health Centre, Montreal, Quebec, Canada (A.D.S.); Department of Preventive Cardiology, CGH Medical Center, Sterling, IL, and University of Illinois College of Medicine, Peoria (P.P.T.); Department of Hypertension, Medical University of Lodz, Poland (M.B.); and Atherotech Diagnostics Laboratory, Birmingham, AL (K.R.K.).
authors.forename: Renato
authors.initials: R
authors.lastname: Quispe
authors.affiliation: From Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (M.B.E., R.Q.,E.D.M., P.P.T., R.S.B., S.R.J., S.S.M.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (M.B.E.); Welch Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (E.D.M., J.C., S.S.M.); Mike Rosenbloom Laboratory for Cardiovascular Research, McGill University Health Centre, Montreal, Quebec, Canada (A.D.S.); Department of Preventive Cardiology, CGH Medical Center, Sterling, IL, and University of Illinois College of Medicine, Peoria (P.P.T.); Department of Hypertension, Medical University of Lodz, Poland (M.B.); and Atherotech Diagnostics Laboratory, Birmingham, AL (K.R.K.).
authors.forename: Erin D
authors.initials: ED
authors.lastname: Michos
authors.affiliation: From Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (M.B.E., R.Q.,E.D.M., P.P.T., R.S.B., S.R.J., S.S.M.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (M.B.E.); Welch Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (E.D.M., J.C., S.S.M.); Mike Rosenbloom Laboratory for Cardiovascular Research, McGill University Health Centre, Montreal, Quebec, Canada (A.D.S.); Department of Preventive Cardiology, CGH Medical Center, Sterling, IL, and University of Illinois College of Medicine, Peoria (P.P.T.); Department of Hypertension, Medical University of Lodz, Poland (M.B.); and Atherotech Diagnostics Laboratory, Birmingham, AL (K.R.K.).
authors.forename: Allan D
authors.initials: AD
authors.lastname: Sniderman
authors.affiliation: From Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (M.B.E., R.Q.,E.D.M., P.P.T., R.S.B., S.R.J., S.S.M.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (M.B.E.); Welch Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (E.D.M., J.C., S.S.M.); Mike Rosenbloom Laboratory for Cardiovascular Research, McGill University Health Centre, Montreal, Quebec, Canada (A.D.S.); Department of Preventive Cardiology, CGH Medical Center, Sterling, IL, and University of Illinois College of Medicine, Peoria (P.P.T.); Department of Hypertension, Medical University of Lodz, Poland (M.B.); and Atherotech Diagnostics Laboratory, Birmingham, AL (K.R.K.).
authors.forename: Peter P
authors.initials: PP
authors.lastname: Toth
authors.affiliation: From Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (M.B.E., R.Q.,E.D.M., P.P.T., R.S.B., S.R.J., S.S.M.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (M.B.E.); Welch Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (E.D.M., J.C., S.S.M.); Mike Rosenbloom Laboratory for Cardiovascular Research, McGill University Health Centre, Montreal, Quebec, Canada (A.D.S.); Department of Preventive Cardiology, CGH Medical Center, Sterling, IL, and University of Illinois College of Medicine, Peoria (P.P.T.); Department of Hypertension, Medical University of Lodz, Poland (M.B.); and Atherotech Diagnostics Laboratory, Birmingham, AL (K.R.K.).
authors.forename: Maciej
authors.initials: M
authors.lastname: Banach
authors.affiliation: From Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (M.B.E., R.Q.,E.D.M., P.P.T., R.S.B., S.R.J., S.S.M.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (M.B.E.); Welch Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (E.D.M., J.C., S.S.M.); Mike Rosenbloom Laboratory for Cardiovascular Research, McGill University Health Centre, Montreal, Quebec, Canada (A.D.S.); Department of Preventive Cardiology, CGH Medical Center, Sterling, IL, and University of Illinois College of Medicine, Peoria (P.P.T.); Department of Hypertension, Medical University of Lodz, Poland (M.B.); and Atherotech Diagnostics Laboratory, Birmingham, AL (K.R.K.).
authors.forename: Krishnaji R
authors.initials: KR
authors.lastname: Kulkarni
authors.affiliation: From Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (M.B.E., R.Q.,E.D.M., P.P.T., R.S.B., S.R.J., S.S.M.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (M.B.E.); Welch Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (E.D.M., J.C., S.S.M.); Mike Rosenbloom Laboratory for Cardiovascular Research, McGill University Health Centre, Montreal, Quebec, Canada (A.D.S.); Department of Preventive Cardiology, CGH Medical Center, Sterling, IL, and University of Illinois College of Medicine, Peoria (P.P.T.); Department of Hypertension, Medical University of Lodz, Poland (M.B.); and Atherotech Diagnostics Laboratory, Birmingham, AL (K.R.K.).
authors.forename: Josef
authors.initials: J
authors.lastname: Coresh
authors.affiliation: From Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (M.B.E., R.Q.,E.D.M., P.P.T., R.S.B., S.R.J., S.S.M.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (M.B.E.); Welch Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (E.D.M., J.C., S.S.M.); Mike Rosenbloom Laboratory for Cardiovascular Research, McGill University Health Centre, Montreal, Quebec, Canada (A.D.S.); Department of Preventive Cardiology, CGH Medical Center, Sterling, IL, and University of Illinois College of Medicine, Peoria (P.P.T.); Department of Hypertension, Medical University of Lodz, Poland (M.B.); and Atherotech Diagnostics Laboratory, Birmingham, AL (K.R.K.).
authors.forename: Roger S
authors.initials: RS
authors.lastname: Blumenthal
authors.affiliation: From Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (M.B.E., R.Q.,E.D.M., P.P.T., R.S.B., S.R.J., S.S.M.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (M.B.E.); Welch Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (E.D.M., J.C., S.S.M.); Mike Rosenbloom Laboratory for Cardiovascular Research, McGill University Health Centre, Montreal, Quebec, Canada (A.D.S.); Department of Preventive Cardiology, CGH Medical Center, Sterling, IL, and University of Illinois College of Medicine, Peoria (P.P.T.); Department of Hypertension, Medical University of Lodz, Poland (M.B.); and Atherotech Diagnostics Laboratory, Birmingham, AL (K.R.K.).
authors.forename: Steven R
authors.initials: SR
authors.lastname: Jones
authors.affiliation: From Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (M.B.E., R.Q.,E.D.M., P.P.T., R.S.B., S.R.J., S.S.M.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (M.B.E.); Welch Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (E.D.M., J.C., S.S.M.); Mike Rosenbloom Laboratory for Cardiovascular Research, McGill University Health Centre, Montreal, Quebec, Canada (A.D.S.); Department of Preventive Cardiology, CGH Medical Center, Sterling, IL, and University of Illinois College of Medicine, Peoria (P.P.T.); Department of Hypertension, Medical University of Lodz, Poland (M.B.); and Atherotech Diagnostics Laboratory, Birmingham, AL (K.R.K.).
authors.forename: Seth S
authors.initials: SS
authors.lastname: Martin
mesh_terms: D000368:Aged; D002784:Cholesterol / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood*; D008078:Cholesterol, LDL / Q000097:blood*; D003430:Cross-Sectional Studies; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys / Q000706:statistics & numerical data; D011159:Population Surveillance
chemical_list: D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D008055:Lipids; D002784:Cholesterol
keywords: cholesterol; lipids; lipoproteins; primary prevention