Non-HDL cholesterol may be better treatment target than LDL

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WESTPORT, CT (Reuters Health) – Non-high-density lipoprotein (non-HDL) cholesterol levels correlate with apolipoprotein B (apo B) levels and may be a better target than LDL for cholesterol-lowering treatments, according to a report in the August 1st issue of The American Journal of Cardiology.

Apo B is a better predictor of coronary heart disease than LDL cholesterol is, the authors explain, but its measurement is less widely available and more expensive than the standard lipid profile.

Dr. Christie M. Ballantyne, from Baylor College of Medicine in Houston, Texas, and colleagues in the ACCESS Study Group investigated whether non-HDL cholesterol (which includes both LDL cholesterol and the cholesterol in triglyceride-rich lipoproteins) correlated with apo B levels in 3916 patients who were randomly assigned to one of five hydroxymethylglutaryl coenzyme A reductase inhibitors ("statins").

Both at baseline and after 54 weeks of treatment, non-HDL cholesterol and apolipoprotein B levels were strongly correlated, the authors report, not only for all five drugs tested but also across coronary heart disease risk categories. Non-HDL cholesterol and apo B levels also strongly correlated across baseline triglyceride strata.

Although treatment brought significant reductions in non-HDL cholesterol levels, the researchers note that patients were less likely to meet their non-HDL cholesterol targets than their LDL-cholesterol targets. This was especially true for patients with coronary heart disease, whose baseline non-HDL levels were higher relative to LDL cholesterol than were those of patients without coronary heart disease.

"The new National Cholesterol Education Program guidelines have suggested that non-HDL cholesterol be used as a target for lipid-lowering drug therapy in patients with triglycerides over 200 mg/dL," Dr. Ballantyne told Reuters Health. "To simplify things for physicians, they have recommended that you add 30 mg to the LDL-cholesterol target. For example, if the LDL-cholesterol target is less than 100 mg/dL, then the non-HDL cholesterol target should be less than 130 mg/dL."

"The most important point to physicians," Dr. Ballantyne emphasized, "is that patients with coronary heart disease or multiple risk factors tend to have non-HDL cholesterol elevations even greater than LDL-cholesterol elevations, and that it may require aggressive therapy to get them to target."

Am J Cardiol 2001;88:265-269.

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