Beyond LDL – Non HDL Cholesterol and Apolipoprotein B

Beyond LDL – non HDL cholesterol and apolipoprotein B

Standard cardiovascular risk predictor is the level of low density lipoprotein cholesterol. Two other lipid risk markers are apolipoprotein B and non–high-density lipoprotein cholesterol. Studies have shown that they perform better than LDL cholesterol in cardiovascular risk prediction both on and off treatment as well in the prediction of risk of subclinical cardiovascular disease. The advantages cited include accuracy independent of triglyceride levels and prandial state of the person when the estimation is done. Non HDL cholesterol is probably a marker of better choice as it has established cut off points with safe and achievable goals. Specifically no additional cost is involved in estimation, only a quick mathematical calculation after a standard lipid profile estimation [1].

Epidemiological concerns of using LDL cholesterol alone has been the recurrence of acute coronary syndromes in up to half of patients with cholesterol within the conventional normal range. Coronary events in those on already on aggressive statin regimens is also of concern [2].

References

  1. Vimal Ramjee, Laurence S Sperling, Terry A Jacobson. Non–High-Density Lipoprotein Cholesterol Versus Apolipoprotein B in Cardiovascular Risk Stratification. J Am Coll Cardiol. 2011 Jul 26;58(5):457-63.
  2. Donald Lloyd-Jones, Robert J Adams, Todd M Brown, Mercedes Carnethon, Shifan Dai, Giovanni De Simone, T Bruce Ferguson, Earl Ford, Karen Furie, Cathleen Gillespie, Alan Go, Kurt Greenlund, Nancy Haase, Susan Hailpern, P Michael Ho, Virginia Howard, Brett Kissela, Steven Kittner, Daniel Lackland, Lynda Lisabeth, Ariane Marelli, Mary M McDermott, James Meigs, Dariush Mozaffarian, Michael Mussolino, Graham Nichol, Véronique L Roger, Wayne Rosamond, Ralph Sacco, Paul Sorlie, Randall Stafford, Thomas Thom, Sylvia Wasserthiel-Smoller, Nathan D Wong, Judith Wylie-Rosett, American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Executive Summary: Heart Disease and Stroke statistics–2010 Update: A Report From the American Heart Association. Circulation. 2010 Feb 23;121(7):948-54.