Lipid Profile With Non-HDL Cholesterol

Overview:

The Third Report of the National Cholesterol Education Program (NCEP) Expert Panel's revised guidelines1 for the treatment of cholesterol in adults called for increased attention to the metabolic syndrome and diabetes. These guidelines highlighted the increased inaccuracy of the LDL-C measurement in these patients because of elevated triglycerides. To overcome the inaccuracy of the calculated LDL-C method when triglycerides are elevated, measurement of nonhigh-density lipoprotein (non-HDL) was recommended as a better means to follow these patients toward their treatment goals. Non-HDL-C is a calculation (total cholesterol minus HDL-C), ie, the sum of the VLDL-C, LDL-C, and IDL-C. While LDL-C has long been the primary focus of cholesterol reduction efforts, researchers have identified several other lipoproteins that also affect cardiovascular health. The advantage of non-HDL-C measurement is that it accounts for cholesterol in the other potentially atherogenic lipoprotein particles, which include VLDL-C, IDL-C, LDL-C, and lipoprotein(a). Studies2,3 have shown that the measurement of non-HDL-C, rather than LDL-C, would be a better target for therapy, especially in persons with a triglyceride level >200 mg/dL. Cut-points for non-HDL-C are 30 mg/dL higher than the LCL-C cut-points (eg, if the patient's LDL-C goal is <160 mg/dL, the non-HDL-C goal should be <190 mg/dL).

LDL cholesterol cannot be calculated if triglyceride is >400 mg/dL.

1. Executive Summary of The Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. JAMA. 2001 May 16; 285(19):2486-2497. PubMed 11368702

2. Lamarche B, Tchernof A, Moorjani S, et al. Small, dense low-density lipoprotein particles as a predictor of the risk of ischemic heart disease in men. Prospective results from the Québec Cardiovascular Study. Circulation.1997 Jan 7; 95(1):69-75. PubMed 8994419

3. Ridker PM, Rifai N, Cook NR, Bradwin G, Buring JE. Non-HDL cholesterol, apolipoproteins A-1 and B100, standard lipid measures, lipid ratios, and CRP as risk factors for cardiovascular disease in women. JAMA. 2005 Jul 20; 294(3):326-333. PubMed 16030277