Lipid Profile With Non-HDL Cholesterol

The Third Report of the National Cholesterol Education Program (NCEP) Expert Panel's revised guidelines¹ for the treatment of cholesterol in adults called for increased attention to the metabolic syndrome and diabetes. These guidelines highlighted the increased inaccuracy of the LDL-C measurement in these patients because of elevated triglycerides. To overcome the inaccuracy of the calculated LDL-C method when triglycerides are elevated, measurement of nonhigh-density lipoprotein (non-HDL) was recommended as a better means to follow these patients toward their treatment goals. Non-HDL-C is a calculation (total cholesterol minus HDL-C), ie, the sum of the VLDL-C, LDL-C, and IDL-C. While LDL-C has long been the primary focus of cholesterol reduction efforts, researchers have identified several other lipoproteins that also affect cardiovascular health. The advantage of non-HDL-C measurement is that it accounts for cholesterol in the other potentially atherogenic lipoprotein particles, which include VLDL-C, IDL-C, LDL-C, and lipoprotein(a). Studies^2,3 have shown that the measurement of non-HDL-C, rather than LDL-C, would be a better target for therapy, especially in persons with a triglyceride level >200 mg/dL. Cut-points for non-HDL-C are 30 mg/dL higher than the LCL-C cut-points (eg, if the patient's LDL-C goal is <160 mg/dL, the non-HDL-C goal should be <190 mg/dL).