Non-HDL-C goals based on the distribution of population percentiles in ELSA-Brasil: Is it time to change?

Brito, Fabiano A.; Pedrosa, William; Maluf, Chams Bicalho; Reis, Rodrigo Citton Padilha dos; Fedeli, Ligia Maria Giongo; Castilhos, Cristina Dickie de; Barreto, Sandhi Maria; Vidigal, Pedro Guatimosim

doi:10.1016/j.atherosclerosis.2018.04.007

Cited by 5 publications

(5 citation statements)

References 28 publications

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“…However, the mean remnant cholesterol concentration differed according to ethnicity, the presence of diabetes, and CKD and was dependent on triglyceride levels, potentially affected by the presence of a low HDL cholesterol concentration. Supported by recent studies, our findings suggest that there is a need for individualization of non-HDL-C goals and reference ranges for patients of different ethnicities, as well as potentially considering other factors, such as triglyceride levels ( 32 – 34 ).…”

Section: Discussionsupporting

confidence: 68%

“…In individuals with type 2 diabetes mellitus (T2DM), there is often combined dyslipidaemia, characterized by reduced HDL, increased LDL, increased triglyceride, and elevated TRLs, which could explain the slight difference in the mean calculated remnant cholesterol concentration in the T2DM group compared with the CVD or CKD groups. Our findings of non-uniform discrepancies between LDL-C and non-HDL-C across different percentiles in different risk groups support the need for further studies to determine the appropriate non-HDL-C goal that corresponds to each LDL-C goal, specifically the elevated remnant cholesterol concentration ( 32 – 34 ). Studies are needed to confirm whether guideline-defined non-HDL targets or a general threshold for remnant cholesterol concentration (e.g., ≥0.65 mmol/L) should be used in clinical practice.…”

Section: Discussionsupporting

confidence: 53%

“…This is because in patients with LDL-C levels of ≤2.6 mmol/L, the mean difference between the LDL-C and non-HDL-C was influenced by the level of triglyceride; a difference of 0.21 mmol/L (19.1 mg/dl) in patients with TG levels of ≤1.7 mmol/L and 0.28 mmol/L (24.6 mg/dl) in patients with TG levels of >1.7 mmol/L ( 33 ). A large study of approximately 15,000 patients in Brazil also showed that non-HDL-C was up to 8 mg/dl lower than the guideline goals, with a significant treatment category discordance between LDL-C and non-HDL-C, particularly for those with low LDL-C (<2.6 mmol/L) and high triglyceride levels (≥1.7 mmol/L) ( 34 ). In our study, we showed that the mean difference between non-HDL-C and dLDL-C was approximately 2 times higher when the triglyceride level was ≥1.7 mmol/L, suggesting the presence of an increased amount of remnant cholesterol concentration (i.e., non-LDL proatherogenic particles).…”

Section: Discussionmentioning

confidence: 99%

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Elevated remnant cholesterol and non-HDL cholesterol concentrations from real-world laboratory results: a cross-sectional study in Southeast Asians

Loh,

Soh,

Tun

et al. 2024

Front. Cardiovasc. Med.

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IntroductionTriglyceride-rich remnant lipoproteins (TRLs) are considered atherogenic due to the presence of remnant cholesterol, which is transported by apolipoprotein B. In clinical practice, the concentration of TRLs can be estimated by calculating remnant cholesterol or non-HDL cholesterol levels.AimThis study aims to investigate the proportion of patients who have low LDL cholesterol (LDL-C) concentration but elevated remnant cholesterol concentration, stratified by the presence of hypertriglyceridaemia and ethnicity, using real-world hospital data. Our secondary aim is to investigate the proportion of patients with elevated non-HDL cholesterol levels using guideline-recommended goals.MethodsA 2-year retrospective study was conducted at a single centre, analyzing lipid blood tests of all patients, including directly measured LDL-C. Fasting for blood tests was not mandatory.ResultsThe study included a total of 21,605 consecutive patients with plasma lipid profiles analyzed in our hospital laboratory. The median age was 61 years. In patients with ASCVD (n = 14,704), 23.7% had an LDL-C level of <1.8 mmol/L, 11.3% had elevated remnant cholesterol concentrations at ≥0.65 mmol/L, and 48.8% were at the non-high-density lipoprotein cholesterol (non-HDL-C) goal (<2.6 mmol/L). Among patients diagnosed with atherosclerotic cardiovascular disease (ASCVD) with LDL-C levels of <1.8 mmol/L (n = 3,484), only 11.9% had high levels of remnant cholesterol, but 96% of the ASCVD patients also achieved the recommended non-HDL-C target of <2.6 mmol/L. When the LDL-C level was <1.8 mmol/L, the mean concentration of remnant cholesterol was 0.214 mmol/L when the triglyceride level was <1.7 mmol/L (n = 3,380), vs. 0.70 mmol/L when the triglyceride level was elevated (n = 724), p < 0.001. Among patients with a triglyceride level of ≥1.7 mmol/L and an LDL-C level of <.8 mmol/L, there were 254 patients with elevated remnant cholesterol concentration and 71 patients with suboptimal non-HDL levels. Malays had a higher mean remnant cholesterol concentration compared with both Chinese and Indians across all LDL-C levels, particularly in the presence of hypertriglyceridaemia.ConclusionsAn elevated remnant cholesterol concentration of >0.65 mmol/L was present in 11% of all patients. The current guideline-recommended non-HDL-C goal, which uses a 0.8 mmol/L estimate of remnant cholesterol concentration, was achieved in >92% of patients, suggesting that it is unlikely to be clinically useful for the majority of our patient population except where there is concomitant hypertriglyceridaemia. Further studies are needed to establish the appropriate non-HDL-C goal or calculated remnant cholesterol concentration, paired with the LDL-C goal or otherwise, in a Southeast Asian population.

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Section: Discussionsupporting

confidence: 68%

Section: Discussionsupporting

confidence: 53%

Section: Discussionmentioning

confidence: 99%

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Elevated remnant cholesterol and non-HDL cholesterol concentrations from real-world laboratory results: a cross-sectional study in Southeast Asians

Loh,

Soh,

Tun

et al. 2024

Front. Cardiovasc. Med.

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“…In both cohort studies, the difference was lower than 30 mg/dl. More recently in 2018, Brito et al investigated 14,837 participants from the Longitudinal Study of Adult Health (ELSA-Brasil) and also found obvious difference and discordance in Brazilian population as the non-HDL-C values, based on correspondent LDL-C population percentiles (70, 100, 130, 160, and 190 mg/dl), were 92, 122, 156, 191, and 223 mg/dl [77].…”

Section: Recommended Value Of Non-hdl-c Goalsmentioning

confidence: 99%

Evidence for changing lipid management strategy to focus on non-high density lipoprotein cholesterol

Kong

Peng

2019

Lipids Health Dis

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Low-density lipoprotein cholesterol (LDL-C) has been recommended as the primary treatment target on lipid management in coronary heart disease (CHD) patients for past several decades. However, even by aggressive LDL-C lowering treatment, patients still present a significant residual risk of major adverse cardiovascular events (MACE). Non-high-density lipoprotein cholesterol (non-HDL-C) contained all the atherogenic lipoproteins, such as chylomicron, very-low density lipoprotein (VLDL), LDL, intermediate density lipoprotein (IDL). Many prospective observation studies have found that non-HDL-C was better than LDL-C in predicting risks of MACE. Since non-HDL-C appears to be superior for risk prediction beyond LDL-C, current guidelines have emphasize the importance of non-HDL-C for guiding cardiovascular prevention strategies and have flagged non-HDL-C as a co-primary therapeutic target. The goals of non-HDL-C were recommended as 30 mg/dl higher than the corresponding LDL-C goals, but the value seemed inappropriate. This review provide evidence for changing lipid management strategy to focus on non-HDL-C and appropriate values for adding to LDL-C goals would be proposed.

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“…More recently, a Brazilian cohort study also reported non-HDL-C values matched with the same population percentile of LDL-C values to be lower than the guidelines indicated targets. 62 Overall, considering non-HDL-C percentile values that match percentiles of LDL-C established thresholds, non-HDL-C target values should be lowered and consequently some individuals could be reclassified into a higher risk category. The reclassification into a higher risk group would be more frequent in patients with low LDL-C and hypertriglyceridemia.…”

Section: Non-high-density Lipoprotein Cholesterol Target Levelsmentioning

confidence: 99%

Non-high-density lipoprotein cholesterol versus low-density lipoprotein cholesterol in clinical practice: ANMCO position paper

Colivicchi

Fusco

Arca

et al. 2021

Journal of Cardiovascular Medicine

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Bloodstream cholesterol is a central contributor to atherosclerotic cardiovascular diseases. For several decades, low-density lipoprotein cholesterol (LDL-C) has been the main biomarker for the prediction of cardiovascular events and therapeutic target of lipid-lowering treatments. More recently, several findings have supported the greater reliability of non-high-density lipoprotein cholesterol (non-HDL-C) as a predictive factor and possible therapeutic target in refining antiatherogenic treatments, especially among patients with lower LDL-C and higher triglyceride values. This article discusses the limits of current standard methods for assessing LDL-C levels and emphasizes the persistent residual cardiovascular risk in patients treated with lipid-lowering agents on the basis of recommended LDL-C targets. It highlights that patients with controlled LDL-C and non-targeted non-HDL-C have a higher cardiovascular risk. The article focuses on the role of non-HDL-C as a better predictor of atherosclerotic disease as compared with LDL-C and as a therapeutic target. Finally, this article includes an executive summary aimed at refining preventive approaches in atherosclerotic cardiovascular disease.

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Non-HDL-C goals based on the distribution of population percentiles in ELSA-Brasil: Is it time to change?

Cited by 5 publications

References 28 publications

Elevated remnant cholesterol and non-HDL cholesterol concentrations from real-world laboratory results: a cross-sectional study in Southeast Asians

Elevated remnant cholesterol and non-HDL cholesterol concentrations from real-world laboratory results: a cross-sectional study in Southeast Asians

Evidence for changing lipid management strategy to focus on non-high density lipoprotein cholesterol

Non-high-density lipoprotein cholesterol versus low-density lipoprotein cholesterol in clinical practice: ANMCO position paper

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