Non-HDL Cholesterol and Apolipoprotein B in the Dyslipidemic Classification of Type 2 Diabetic Patients

Abstract

OBJECTIVE -To compare non-HDL cholesterol (HDLc) and apolipoprotein B (apoB) in the identification of nonconventional high-risk dyslipidemic phenotypes in type 2 diabetic patients.RESEARCH DESIGN AND METHODS -Total cholesterol and triglycerides, HDLc, LDL cholesterol, non-HDLc, apolipoprotein B (apoB), and LDL size were determined in 122 type 2 diabetic patients (68% male, aged 59.6 Ϯ 9.7 years, and HbA 1c 7.5% [range 5.2-16.0]). They were then classified as normo-and hypertriglyceridemic if their triglyceride concentrations were below/above 2.25 mmol/l, as normo/hyper-non-HDLc if non-HDLc concentrations were below/ above 4.13 mmol/l, and as normo-and hyperapoB if apoB concentrations were below/above 0.97 g/l. Both classifications were compared (concordance assessed with the index), and low HDLc and LDL phenotype B were identified in each category.RESULTS -A total of 26 patients were hypertriglyceridemic and 96 were normotriglyceridemic. All hypertriglyceridemic subjects had increased non-HDLc, whereas 24 had increased apoB (ϭ 0.95). In the normotriglyceridemic group, 44 had increased non-HDLc, 68 had increased apoB, and 25 of the 52 patients with normal non-HDLc had increased apoB (ϭ 0.587). Low HDLc and LDL phenotype B were similarly distributed into the equivalent categories.CONCLUSIONS -Non-HDLc and apoB are equivalent risk markers in hypertriglyceridemic patients, but apoB identifies additional patients with high-risk dyslipidemic phenotypes in normotriglyceridemic type 2 diabetic patients. Diabetes Care 26:2048 -2051, 2003L DL cholesterol (LDLc) is the main therapeutic target in the treatment of dyslipidemia (1,2). Nevertheless, several epidemiologic studies have shown that both non-HDL cholesterol (HDLc) and apolipoprotein B (apoB) are better predictors of cardiovascular events than LDLc (3-5). The former has, in fact, been included as a therapeutic target for hypertriglyceridemic patients in the most recent National Cholesterol Education Program (NCEP) recommendations (1) and is easy and cheap to calculate. On the other hand, apoB identifies high-risk dyslipidemic phenotypes that are not detected by the standard lipid profile in type 2 diabetic patients, who may present with hyperapoB-dependent dyslipidemic phenotypes (6,7). Because of the high correlation between non-HDLc and apoB in nondiabetic subjects (8), non-HDLc is considered a good surrogate marker for apoB. To our knowledge, however, no comparison has been made between nonHDLc and apoB in the classification of patients into dyslipidemic phenotypes.The aim of this study was to compare the classification into nonconventional dyslipidemic phenotypes of a group of type 2 diabetic subjects using apoB and non-HDLc. RESEARCH DESIGN AND METHODS PatientsA total of 122 type 2 diabetic patients from a university hospital were consecutively included in the study. Those receiving treatments or who were in situations (unrelated to their diabetes) that are known to affect lipid metabolism were excluded. Patients with hypertension were not treated with nonselec...

Effect of age on the association of non-high-density-lipoprotein cholesterol and apolipoprotein B with cardiovascular mortality in a Mediterranean population with type 2 diabetes: the Casale Monferrato study

“…ApoB predicts mortality from cardiovascular disease even in the presence of normal or low non-HDL-cholesterol values. A detailed study has shown that measurements of ApoB provide a better estimate of small dense LDL particles, which are not detected by simple measurement of non-HDL-cholesterol [14]. Our findings are therefore consistent with those of others [8].…”

“…As small, dense LDL particles, which are strongly associated with cardiovascular disease, contain less cholesterol than large buoyant LDL, measurement of LDLcholesterol will clearly result in underestimation of the risk due to LDL [13,14]. To overcome this limitation and to take into account the cholesterol in VLDL, the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) recommended that non-HDL-cholesterol be used instead of LDL-cholesterol for people with the metabolic syndrome [15].…”

Tesaglitazar, a novel dual peroxisome proliferator-activated receptor α/γ agonist, dose-dependently improves the metabolic abnormalities associated with insulin resistance in a non-diabetic population

“…High non-HDL-cholesterol levels are an indicator of vascular risk [25] and the National Cholesterol Education Program Adult Treatment Panel III guidelines now spe- cifically recommend therapy in patients with hypertriglyceridaemia [17]. Changes in non-HDL-cholesterol (i.e.…”

Circulating Oxidized Low Density Lipoprotein and Non-High Density Lipoprotein Cholesterol Concentrations in Metabolic Syndrome Egyptian Women Before and After Specific Nutritional Therapy

“…Atherogenic dyslipidemia which is one of the most important component of MetS is associated with increased risk of cardiovascular disease [8]. Accordingly, two approaches had been used in this study to investigate the abnormality in the lipid profiles among both obese and MetS patients, by determining ox-LDL-C, a marker of lipoprotein-associated oxidative stress, and non HDLC, and their response after using the two different dietary methods.…”

“…Therefore, measurement of Apo B provides direct information on the number of atherogenic particles (LDL and non LDL), irrespective of their size. Further, these atherogenic particles, collectively known as non-HDL lipoproteins, are associated with atherogenic dyslipidaemia, insulin resistance, portal hyperinsulinemia and metabolic syndrome [8,9].…”