Non-HDL-cholesterol as valid surrogate to apolipoprotein B100 measurement in diabetes: Discriminant Ratio and unbiased equivalence

Abstract

BackgroundApolipoprotein B100 (apoB) is a superior indicator of CV risk than total or LDL-C. Non-HDL-C represents a simple surrogate for apoB in hypertriglyceridemic and/or T2DM patients. ApoB and non-HDL-C show high correlation, although the degree of mutual concordance remains debated in CV risk evaluation.ObjectivesWe used the Discriminant Ratio (DR) methodology to compare the performance of non-HDL-C with that of apoB to rank diabetic patients according to dyslipidemia and to establish the underlying relationship between these variables taking measurement noise and intra-/intersubject variation into account, and to derive an unbiased equivalence equation.MethodsFasting total C, HDL-C, apoB and triglycerides were measured in 45 diabetic patients. The DR of the underlying between-subject standard deviation (SD) to the within-subject SD was calculated from duplicates. Correlation coefficients between pairs were adjusted to include an estimate of the underlying correlation.ResultsMean values [day 1 (1SD)] were 143 (36) mg/dl (non-HDL-C) and 98 (24) mg/dl (apoB). The DR's of both parameters were similar (1.76 and 1.83) (p = 0.83). Pearson's product-moment correlation coefficient between tests was very high (0.94), reaching unity (1.00) after attenuation adjustment. The unbiased equation of equivalence relating apoB to non-HDL-C had a slope of 0.65 and an intercept of 6.3 mg/dl.ConclusionsThe discrimination power of non-HDL-C is similar to that of apoB to rank diabetic patients according to atherogenic cholesterol and lipoprotein burden. Since true correlation between variables reached unity, non-HDL-C may provide not only a metabolic surrogate but also a candidate biometrical equivalent to apoB, as non-HDL-C calculation is readily available.

Relation of Combined Non–High-Density Lipoprotein Cholesterol and Apolipoprotein B With Atherosclerosis in Adults With Type 1 Diabetes Mellitus

“…Some authors believe apoB may provide a more complete picture of the lipoprotein profile as it will account for small, dense, more atherogenic particles [24]. Proponents of apoB also argue that the apoB concept is intrinsically easier to understand than nonHDL-C, which represents “a state of otherness” defined by a non-number, instead of a single atherogenic lipid variable [25-27]. …”

The effect of thriphala, a herbal Ayurveda formulation, on serum lipids, in patients on a maintenance dose of atorvastatin for hyperlipidaemia: a randomized controlled trial

“…Apolipoprotein B (apo B) is recognised as a risk factor of atherosclerotic disease, which may be superior in predictive value when compared to total and LDL cholesterol. Studies have shown that non-HDL-C is a simple surrogate of apo B levels, and that non-HDL-C shows a higher correlation with atherosclerotic cardiovascular disease than apo B [23].…”

Lipid ratios, atherogenic coefficient and atherogenic index of plasma as parameters in assessing cardiovascular risk in type 2 diabetes mellitus

“…8 Studies have shown Non-HDL-c being analogous to Apo-B in assessing atherogenic cholesterol and lipoprotein burden. 22 The apolipoprotein B assay is not routinely available because of its cost and general unfamiliarity with its interpretation outside of the research setting. Because of its simple calculation, the Non-HDL Cholesterol level is easily available with every lipid profile ordered and eliminating any additional costs.…”