Non-high density lipoprotein cholesterol versus low density lipoprotein cholesterol as a discriminating factor for myocardial infarction

Abstract

BackgroundSerum total cholesterol (TC) and LDL cholesterol (LDL-C) have been used as major laboratory measures in clinical practice to assess cardiovascular risk in the general population and disease management as well as prognosis in patients. However, some studies have also reported the use of non-HDL cholesterol (non-HDL-C). As non-HDL-C can be calculated by subtracting HDL-C from TC, both of which do not require fasting blood sample in contrast to LDL-C which requires fasting blood sample, we aimed to compare non-HDL-C with LDL-C as a predictor of myocardial infarction (MI).MethodsThis hospital based cross sectional study was undertaken among 51 cases of MI and equal number of controls. MI was diagnosed based on the clinical history, ECG changes and biochemical parameters. 5 mL of fasting blood sample was collected from each research participant for the analysis of lipid profile. Non-HDL-C was calculated by using the equation; Non-HDL-C = TC – HDL-C. Statistical analysis was performed using SPSS 14.0.Results42 MI cases were dyslipidemic in contrast to 20 dyslipidemic subjects under control group. The differences in the median values of each lipid parameter were statistically significant between MI cases and controls. The lipid risk factors most strongly associated with MI were HDL-C (OR 5.85, 95% CI 2.41-14.23, P value = 0.000) followed by non-HDL-C (OR 3.77, 95% CI 1.64-8.66, P value = 0.002), LDL-C/HDL-C (OR 3.38, 95% CI 1.44-7.89, P value = 0.005), TC/HDL-C (OR 2.93, 95% CI 1.36-7.56, P value = 0.026), LDL-C (OR 2.70, 95% CI 1.20-6.10, P value = 0.017), TC (OR 2.68, 95% CI 1.04-6.97, P value = 0.042) and Tg (OR 2.54, 95% CI 1.01-6.39, P value = 0.047). Area under the receiver operating curve was greater for non-HDL-C than for LDL-C. Non-HDL-C was also found to be more sensitive and specific than LDL-C for MI.ConclusionsHDL-C and non-HDL-C are better discriminating parameters than LDL-C for MI. Thus, we can simply perform test for HDL-C and non-HDL-C both of which do not require fasting blood sample rather than waiting for fasting blood sample to measure LDL-C.

The association of dyslipidemia with erythrocyte aggregation

“…Hence, the European Atherosclerosis Society consensus panel recommends elevated TG and low HDL-C as targets for treatment [25]. The association of HDL-C with myocardial infarction was found to be stronger than LDL-C in the study of Sigdel et al [26], possibly indicating that HDL-C could be the major determinant of clinical outcomes. The findings from the present study emphasize that HDL-C and TG should be given equal, if not more, importance than other routinely measured lipid parameters in the context of blood rheology and CVD.…”

Association of Lipids With Incident Heart Failure Among Adults With and Without Diabetes Mellitus

“…9 HDL-C is strongly associated with MI. 32 Because the association of HDL-C with incident HF was independent of interim MI in participants with diabetes, we speculated that alternative pathways possibly occurring before MI may play a greater role in this association. Insulin resistance is an independent predictor of HF, 25,33 but also has a role in the development of high triglyceride and low HDL-C levels.…”

Trends in cardiovascular disease risk factors by obesity level in adults in the United States, NHANES 1999‐2010

“…Therefore, it is possible that we have overestimated the prevalence of total hypertension and the prevalence of untreated hypertension based on this recent recommendation. Similarly, while the recommendations in the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation and Treatment of High Cholesterol in Adults (ATP III) focus on total cholesterol with non‐HDL cholesterol as a secondary target, recent studies have found non‐HDL cholesterol to be an independent predictor of CVD risk .…”