open access

Vol 13, No 5 (2018)
Review Papers
Published online: 2018-09-13
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Non-HDL-cholesterol: better than LDL-cholesterol in reflecting cardiovascular risk?

Grażyna Sygitowicz, Krzysztof J. Filipiak, Dariusz Sitkiewicz
DOI: 10.5603/FC.a2018.0090
·
Folia Cardiologica 2018;13(5):435-441.

open access

Vol 13, No 5 (2018)
Review Papers
Published online: 2018-09-13

Abstract

The concentration of lipids and lipoproteins in plasma is essential in the treatment of lipid disorders. The routine lipid
panel includes total cholesterol, triglycerides, cholesterol of low-density lipoprotein (LDL-C) and cholesterol of high-
-density lipoprotein (HDL-C). The latest guidelines of the European Society of Cardiology (valid until 2020) indicate that
besides many players in the lipid arena (apolipoprotein, concentration and size of LDL particles) another parameter,
non-HDL-cholesterol (non-HDL-C), is very important. This parameter, being easily available for routine clinical use, has
been highlighted as a key secondary goal of therapy in patients with cardiometabolic risk.
Non-HDL-C is a superior parameter to LDL-C, especially the one estimated using Friedewald formula for prediction of cardiovascular events, because non-HDL-C is an integrated complex of all lipoprotein particles containing apolipoprotein B,
i.e.: LDL, very low-density lipoproteins, intermediate-density lipoproteins, chylomicrons, remnants and Lp(a). Crucially, it
can be calculated directly from the values of routine lipid panels, without additional cost.
In our opinion, non-HDL-C should be presented in all routine lipid profiles conducted by diagnostic laboratories. We
also propose a new presentation of the results of routine lipid panel, which allows a significant change in treatment
goals, taking into account the hierarchy of values of individual concentrations of lipoprotein fractions and how they are
interpreted in the management of dyslipidaemia for optimal prevention of atherosclerosis and cardiovascular diseases.

Abstract

The concentration of lipids and lipoproteins in plasma is essential in the treatment of lipid disorders. The routine lipid
panel includes total cholesterol, triglycerides, cholesterol of low-density lipoprotein (LDL-C) and cholesterol of high-
-density lipoprotein (HDL-C). The latest guidelines of the European Society of Cardiology (valid until 2020) indicate that
besides many players in the lipid arena (apolipoprotein, concentration and size of LDL particles) another parameter,
non-HDL-cholesterol (non-HDL-C), is very important. This parameter, being easily available for routine clinical use, has
been highlighted as a key secondary goal of therapy in patients with cardiometabolic risk.
Non-HDL-C is a superior parameter to LDL-C, especially the one estimated using Friedewald formula for prediction of cardiovascular events, because non-HDL-C is an integrated complex of all lipoprotein particles containing apolipoprotein B,
i.e.: LDL, very low-density lipoproteins, intermediate-density lipoproteins, chylomicrons, remnants and Lp(a). Crucially, it
can be calculated directly from the values of routine lipid panels, without additional cost.
In our opinion, non-HDL-C should be presented in all routine lipid profiles conducted by diagnostic laboratories. We
also propose a new presentation of the results of routine lipid panel, which allows a significant change in treatment
goals, taking into account the hierarchy of values of individual concentrations of lipoprotein fractions and how they are
interpreted in the management of dyslipidaemia for optimal prevention of atherosclerosis and cardiovascular diseases.

Get Citation

Keywords

non-HDL-C, LDL-C, routine lipid panel

About this article
Title

Non-HDL-cholesterol: better than LDL-cholesterol in reflecting cardiovascular risk?

Journal

Folia Cardiologica

Issue

Vol 13, No 5 (2018)

Pages

435-441

Published online

2018-09-13

DOI

10.5603/FC.a2018.0090

Bibliographic record

Folia Cardiologica 2018;13(5):435-441.

Keywords

non-HDL-C
LDL-C
routine lipid panel

Authors

Grażyna Sygitowicz
Krzysztof J. Filipiak
Dariusz Sitkiewicz

References (19)
  1. Oliveira GBF, Avezum A, Roever L. Cardiovascular disease burden: evolving knowledge of risk factors in myocardial infarction and stroke through population-based research and perspectives in global prevention. Front Cardiovasc Med. 2015; 2: 1–32.
  2. Choi HY, Hafiane A, Schwertani A, et al. High-Density lipoproteins: biology, epidemiology, and clinical management. Can J Cardiol. 2017; 33(3): 325–333.
  3. Zdrojewski T, Jankowski P, Bandosz P, et al. Nowa wersja systemu oceny ryzyka sercowo-naczyniowego i tablic SCORE dla populacji Polski. Kardiologia Polska. 2015; 73(10): 958–961.
  4. Catapano A, Graham I, Backer GDe, et al. Wytyczne ESC/EAS dotyczące leczenia zaburzeń lipidowych w 2016 roku. Kardiologia Polska. 2016; 74(11): 1234–1318.
  5. Wożakowska-Kapłon B, Filipiak K, Mamcarz A, et al. Sekcja Farmakoterapii Sercowo-Naczyniowej Polskiego Towarzystwa Kardiologicznego. Aktualne problemy terapii dyslipidemii w Polsce — II Deklaracja Sopocka. Stanowisko grupy ekspertów wsparte przez Sekcję Farmakoterapii Sercowo-Naczyniowej Polskiego Towarzystwa Kardiologicznego. Kardiologia Polska. 2014; 72(9): 847–853.
  6. Wang GJ, Chang CT, Yang CY, et al. Negatively charged L5 as a naturally occurring atherogenic low-density lipoprotein. BioMedicine. 2012; 2(4): 147–154.
  7. Stancel N, Chen CC, Ke LY, et al. Interplay between CRP, atherogenic LDL, and LOX-1 and its potential role in the pathogenesis of atherosclerosis. Clin Chem. 2016; 62(2): 320–327.
  8. Camont L, Chapman MJ, Kontush A. Biological activities of HDL subpopulations and their relevance to cardiovascular disease. Trends Mol Med. 2011; 17(10): 594–603.
  9. Libby P, Ridker P, Maseri A. Inflammation and atherosclerosis. Circulation. 2002; 105(9): 1135–1143.
  10. Sokolov AV, Kostevich VA, Runova OL, et al. Proatherogenic modification of LDL by surface-bound myeloperoxidase. Chem Phys Lipids. 2014; 180: 72–80.
  11. Khera AV, Plutzky J. Management of low levels of high-density lipoprotein-cholesterol. Circulation. 2013; 128(1): 72–78.
  12. Sniderman AD, Toth PP, Thanassoulis G, et al. An evidence-based analysis of the National Lipid Association recommendations concerning non-HDL-C and apoB. J Clin Lipidol. 2016; 10(5): 1248–1258.
  13. Liao P, Zeng R, Zhao X, et al. Prognostic value of non-high-density lipoprotein cholesterol for mortality in patients with coronary heart disease: a systematic review and meta-analysis. Int J Cardiol. 2017; 227: 950–955.
  14. Liu H, Deng X, Peng Y, et al. Meta-analysis of serum non-high-density lipoprotein cholesterol and risk of coronary heart disease in the general population. Clin Chim Acta. 2017; 471: 23–28.
  15. Nordestgaard BG, Langsted A, Mora S, et al. European Atherosclerosis Society (EAS), European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) Joint Consensus Initiative. Fasting is not routinely required for determination of a lipid profile: clinical and laboratory implications including flagging at desirable concentration cutpoints. Clin Chem. 2016; 62(7): 930–946.
  16. Nauck M, Warnick GR, Rifai N. Methods for measured of LDL-cholesterol: a critical assessment of direct measurement by homogenous assays versus calculation. Clin Chem. 2002; 48(2): 236–254.
  17. Sniderman A, McQueen M, Contois J, et al. Why is non-high-density lipoprotein cholesterol a better marker of the risk of vascular disease than low-density lipoprotein cholesterol? J Clin Lipidol. 2010; 4(3): 152–155.
  18. Roever L, Biondi-Zoccai G, Chagas AC. Non-HDL-C vs. LDL-C in predicting the severity of coronary atherosclerosis. Heart Lung Circ. 2016; 25(10): 953–954.
  19. Filipiak KJ. Atorwastatyna i rosuwastatyna — co nowego dla pacjentów w wytycznych Europejskiego Towarzystwa Kardiologicznego dotyczących dyslipidemii w 2016 roku? Statyny — które i w jakich dawkach? Spojrzenie eksperta z perspektywy początku 2017 roku. Kardiol Pol. 2017; 75(Suppl 1): 1–12.

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