Non-HDL cholesterol should not generally replace LDL cholesterol in the management of hyperlipidaemia

Handrean Soran, Jan H. Ho, Safwaan Adam, Paul N. Durrington

Research output: Contribution to journalReview articlepeer-review

Abstract

Purpose of reviewNon-HDL cholesterol was originally conceived as a therapeutic target for statin treatment in hypertriglyceridaemia when apolipoprotein B100 assays were not widely available. Recently non-HDL cholesterol has been recommended to replace LDL cholesterol in the clinical management of dyslipidaemia routinely in general medical practice. This is misguided.Recent findingsNon-HDL cholesterol is heterogeneous, constituting a mixture of triglyceride-rich VLDL, intermediate density lipoprotein and LDL in which small dense LDL is poorly represented and to which VLDL cholesterol contributes increasingly as triglyceride levels rise. This makes it unsuitable as a goal of lipid-lowering treatment or as an arbiter of who should receive such treatment. Results of trials designed to lower LDL cholesterol are not easily translated to non-HDL cholesterol. Fasting is no longer thought essential for screening the general population for raised LDL cholesterol. ApoB100 measurement also does not require fasting even in rarer more extreme lipoprotein disorders encountered in the Lipid Clinic, provides greater precision and specificity and overcomes the problems posed by LDL and non-HDL cholesterol. It is more easily interpreted both in diagnosis and as a therapeutic goal and it includes SD-LDL.SummaryIf we are to discourage use of LDL cholesterol, it should be in favour of apoB100 not non-HDL cholesterol.

Original languageEnglish
Pages (from-to)263-272
Number of pages10
JournalCurrent opinion in lipidology
Volume30
Issue number4
DOIs
Publication statusPublished - 1 Aug 2019

Keywords

  • apolipoprotein B100
  • cardiovascular disease risk
  • LDL cholesterol
  • non-HDL cholesterol
  • statins
  • therapeutic targets

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