Journal of Clinical Lipidology
Volume 4, Issue 3 , Pages 152-155, May 2010

Why is non−high-density lipoprotein cholesterol a better marker of the risk of vascular disease than low-density lipoprotein cholesterol?

  • Allan Sniderman, MD

      Affiliations

    • Mike Rosenbloom Laboratory for Cardiovascular Research, McGill University Health Centre, Room H7.22, Royal Vic Hosp, 687 Pine Avenue West, Montreal, Quebec H3A 1A1, Canada
    • Corresponding Author InformationCorresponding author.
    • ,
  • Matt McQueen, MD, PhD

      Affiliations

    • Population Health Research Institute, McMaster University, Hamilton, ON, Canada
    • ,
  • John Contois, PhD

      Affiliations

    • Maine Standards Company, Windham, ME, USA
    • ,
  • Ken Williams, PhD

      Affiliations

    • KenAnCo Biostatistics and University of Texas Health Science Centre at San Antonio, TX, USA
    • ,
  • Curt D. Furberg, MD, PhD

      Affiliations

    • Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA

Received 4 March 2010; accepted 9 March 2010. published online 22 March 2010.

Abstract

Low-density lipoprotein cholesterol (LDL-C) has been the focus of managing lipoprotein disorders for decades. It is now time to consider a change. Both apolipoprotein B (apoB) and non-high-density lipoprotein cholesterol (HDL-C) have been shown to be more accurate markers of cardiovascular risk than LDL-C. ApoB measures total atherogenic particle number, of which 90% are LDL particles. Therefore, LDL particle number determines plasma apoB in most patients. Non-HDL-C is widely assumed to be superior to LDL-C when triglyceride concentrations are elevated (even modestly) because it includes the cholesterol in very-low-density lipoprotein. However, evidence does not support this concept. Rather, non-HDL-C appears to be an indirect way of estimating apoB. We argue that we should integrate the information from non-HDL-C and apoB for better risk assessment and a better target of therapy.

Keywords: apoB, Cardiovascular disease, Non-HDL–C, Risk factors, VLDL-C

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PII: S1933-2874(10)00104-2

doi:10.1016/j.jacl.2010.03.005

Journal of Clinical Lipidology
Volume 4, Issue 3 , Pages 152-155, May 2010

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