The role of non-HDL cholesterol in risk stratification for coronary artery disease

Current Atherosclerosis Reports

Volumn 14, Issue 2, 2012, Pages 130-134

  Rana, Jamal S ^a   Boekholdt, S Matthijs ^b   Kastelein, John J P ^b   Shah, Prediman K ^a  

^a CEDARS SINAI MEDICAL CENTER   (United States)

^b UNIVERSITY OF AMSTERDAM   (Netherlands)

Author keywords

Apolipoprotein B; Coronary heart disease; Low density lipoprotein cholesterol; Non HDL cholesterol

Indexed keywords

APOLIPOPROTEIN B; ATORVASTATIN; CHOLESTEROL; LOW DENSITY LIPOPROTEIN CHOLESTEROL; NON HIGH DENSITY LIPOPROTEIN CHOLESTEROL; TRIACYLGLYCEROL; UNCLASSIFIED DRUG;

CONCENTRATION (PARAMETERS); CORONARY ARTERY DISEASE; CORONARY RISK; DIABETES MELLITUS; DISEASE ASSOCIATION; DOSE RESPONSE; DRUG DOSE COMPARISON; DRUG EFFICACY; FOLLOW UP; HEART PROTECTION; HIGH RISK PATIENT; HUMAN; ISCHEMIC HEART DISEASE; LIPID ANALYSIS; LIPID COMPOSITION; MONOTHERAPY; NUCLEAR MAGNETIC RESONANCE; PARTICLE SIZE; PROTEIN FUNCTION; REVIEW; RISK ASSESSMENT; RISK FACTOR; RISK REDUCTION;

ADULT; AGED; APOLIPOPROTEINS B; CHOLESTEROL, HDL; CHOLESTEROL, LDL; CORONARY ARTERY DISEASE; FEMALE; HUMANS; HYPERCHOLESTEROLEMIA; HYPOLIPIDEMIC AGENTS; MALE; MIDDLE AGED; PRACTICE GUIDELINES AS TOPIC; PREDICTIVE VALUE OF TESTS; PROGNOSIS; RISK ASSESSMENT; SURVIVAL RATE; TREATMENT OUTCOME;

EID: 84861227320     PISSN: 15233804     EISSN: 15346242     Source Type: Journal    
DOI: 10.1007/s11883-011-0224-x     Document Type: Review

References (30)

1. Kannel WB, Dawber TR, Thomas Jr HE, McNamara PM. Comparison of serum lipids in the prediction of coronary heart disease. Framingham Study indicates that cholesterol level and blood pressure are major factors in coronary heart disease; effect of obesity and cigarette smoking also noted. R I Med J. 1965;48:243-50.
2. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet. 1994;344:1383-9.
3. The Long-Term Intervention with Pravastatin in Ischaemic Disease (LIPID) Study Group. Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med. 1998;339:1349-57.
4. Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial. Lancet. 2002;360:7-22.
5. Sacks FM, Pfeffer MA, Moye LA, on behalf of the Cholesterol and Recurrent Events Trial Investigators, et al. The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. N Engl J Med. 1996;335:1001-9. (Pubitemid 26338729)
6. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA. 2001;285:2486-97.
7. Grundy SM, Cleeman JI, Daniels SR, on behalf of the American Heart Association and National Heart, Lung, and Blood Institute, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute scientific statement. Circulation. 2005;112:2735-52. (Pubitemid 41532612)
8. Robinson JG. Are you targeting non-high-density lipoprotein cholesterol? J AmColl Cardiol. 2009;55(1):42-4. This is an editorial outlining the importance of measuring and targeting non-HDL cholesterol.
9. Fruchart JC, Sacks F, Hermans MP, Assmann G, Brown WV, Ceska R, Chapman MJ, Dodson PM, Fioretto P, Ginsberg HN, Kadowaki T, Lablanche JM, Marx N, Plutzky J, Reiner Z, Rosenson RS, Staels B, Stock JK, Sy R,Wanner C, Zambon A, Zimmet P. The residual risk reduction Initiative: a call to action to reduce residual vascular risk in patients with dyslipidemia. Am J Cardiol. 2008;102 (10 Suppl):1K-34K.
10. LaRosa JC, Grundy SM, Waters DD, Shear C, Barter P, Fruchart JC, Gotto AM, Greten H, Kastelein JJ, Shepherd J, Wenger NK, for the Treating to New Targets (TNT) Investigators. Intensive lipid lowering with atorvastatin in patients with stable coronary disease. N Engl J Med. 2005;352:1425-35. (Pubitemid 40471450)
11. Cannon CP, Braunwald E, McCabe CH, Rader DJ, Rouleau JL, Belder R, Joyal SV, Hill KA, Pfeffer MA, Skene AM, for the Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis in Myocardial Infarction-22 Investigators. Intensive versus moderate lipid lowering with statins after acute coronary syndromes. N Engl J Med. 2004;350:1495-504.
12. Baigent C, Keech A, Kearney PM, Blackwell L, Buck G, Pollicino C, Kirby A, Sourjina T, Peto R, Collins R, Simes R, for the Cholesterol Treatment Trialists' (CTT) Collaborators. Efficacy and safety of cholesterol-lowering treatment: prospective metaanalysis of data from 90,056 participants in 14 randomised trials of statins. Lancet. 2005;366:1267-78.
13. Kearney PM, Blackwell PM, Collins R, Keech A, Simes J, Peto R, Armitage J, Baigent C, for the Cholesterol Treatment Trialists' (CTT) Collaborators. Efficacy of cholesterol-lowering therapy in 18,686 people with diabetes in 14 randomised trials of statins: a metaanalysis. Lancet. 2008;371:117-25.
14. Milani RV, Lavie CJ. Another step forward in refining risk stratification: moving past low-density lipoprotein cholesterol. J Am Coll Cardiol. 2011;58:464-6.
15. Pischon T, Girman CJ, Sacks FM, Rifai N, Stampfer MJ, Rimm EB. Non-high-density lipoprotein cholesterol and apolipoprotein B in the prediction of coronary heart disease in men. Circulation. 2005;112:3375-83. (Pubitemid 43739551)
16. Cui Y, Blumenthal RS, Flaws JA, et al. Non-high-density lipoprotein cholesterol level as a predictor of cardiovascular disease mortality. Arch Intern Med. 2001;161:1413-9. (Pubitemid 32681162)
17. Ingelsson E, Schaefer EJ, Contois JH, et al. Clinical utility of different lipid measures for prediction of coronary heart disease in men and women. JAMA. 2007;298:776-85. (Pubitemid 47263160)
18. Liu J, Sempos CT, Donahue RP, Dorn J, Trevisan M, Grundy SM. Non-high-density lipoprotein and very-low-density lipoprotein cholesterol and their risk predictive values in coronary heart disease. Am J Cardiol. 2006;98:1363-8. (Pubitemid 44666646)
19. Liu J, Sempos C, Donahue RP, Dorn J, Trevisan M, Grundy SM. Joint distribution of non-HDL and LDL cholesterol and coronary heart disease risk prediction among individuals with and without diabetes. Diabetes Care. 2005;28:1916-21. (Pubitemid 41060963)
20. Mora S, Otvos JD, Rifai N, Rosenson RS, Buring JE, Ridker PM. Lipoprotein particle profiles by nuclear magnetic resonance compared with standard lipids and apolipoproteins in predicting incident cardiovascular disease in women. Circulation. 2009;119:931- 9. In this prospective study of healthy women, cardiovascular disease risk prediction associated with lipoprotein profiles evaluated by NMR was comparable but not superior to that of standard lipids or apolipoproteins.
21. Emerging Risk Factors Collaboration, Di Angelantonio E, Sarwar N, Perry P, Kaptoge S, Ray KK, Thompson A, Wood AM, Lewington S, SattarN, Packard CJ,Collins R, Thompson SG,Danesh J. Major lipids, apolipoproteins, and risk of vascular disease. JAMA. 2009;302:1993-2000. An analysis of more than 300 000 people demonstrated that lipid assessment in vascular disease can be simplified by measurement of either cholesterol levels or apolipoproteins without the need to fast and without regard to triglyceride. Hazard ratios with non-HDL-C and HDL-C were nearly identical to those seen with apoB and apoA-I.
22. Arsenault BJ, Rana JS, Stroes ESG, et al. Beyond low-density lipoprotein cholesterol: respective contributions of non- highdensity lipoprotein cholesterol levels, triglycerides, and the total cholesterol/high-density lipoprotein cholesterol ratio to coronary heart disease risk in apparently healthy men and women. J Am Coll Cardiol. 2010;55:35-41. This analyses showed that that irrespective of LDL-C levels, participants with elevated non- HDL-C levels have a substantially higher risk of developing CHD. Also, non-HDL-C levels not only account for the risk associated with LDL-C, but also provide more information about CHD risk associated with elevated lipid levels than LDL-C levels alone.
23. Sniderman AD, Williams K, Contois JH, et al. A meta-analysis of low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, and apolipoprotein B as markers of cardiovascular risk. Circ Cardiovasc Qual Outcomes. 2011;4:337-45. This metaanalysis including 23,455 subjects and 22,950 events evaluated relative risk ratio for cardiovascular risk between LDL, non-HDL-C, and apoB.
24. Lavie CJ, Milani RV, O'Keefe JH. To B or not to B: is noñHighdensity lipoprotein cholesterol an adequate surrogate for apolipoprotein B? Mayo Clin Proc. 2010;85:446-50.
25. Holme I, Aastveit AH, Jungner I,Walldius G. Relationships between lipoprotein components and risk of myocardial infarction: age, gender and short versus longer follow-up periods in the Apolipoprotein MOrtality RISk study (AMORIS). J Intern Med. 2008;264:30-8. (Pubitemid 351813479)
26. McQueen MJ, Hawken S, Wang X, et al. Lipids, lipoproteins, and apolipoproteins as risk markers of myocardial infarction in 52 countries (the INTERHEART study): a case-control study. Lancet. 2008;372:224-33. (Pubitemid 351978112)
27. Yusuf S, Hawken S, Ounpuu S, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364:937-52. (Pubitemid 39208455)
28. Ramjee V, Sperling LS, Jacobson TA. Non-high-density lipoprotein cholesterol versus apolipoprotein B in cardiovascular risk stratification: do the math. J Am Coll Cardiol. 2011;58:457-63. This is a comprehensive commentary on comparison between non- HDL-C and apoB, concluding that non-HDL-C is a better marker of choice for cardiovascular risk stratification at the present time.
29. Kastelein JJP, van der Steeg W, Holme I, et al. Lipids, apolipoproteins, and their ratios in relation to cardiovascular events with statin treatment. Circulation. 2008;117:3002-9.
30. Robinson JG,Wang S, Smith BJ, Jacobson TA. Meta-analysis of the relationship between non- high-density lipoprotein cholesterol reduction and coronary heart disease risk. J Am Coll Cardiol. 2009;53:316-22. This important meta-analysis showed that non- HDL-C is an important target of therapy for CHD prevention. Most lipid-modifying drugs used as monotherapy have an approximately 1:1 relationship between percent non-HDL-C lowering and CHD reduction.