Abstract 440: Non-HDL Cholesterol, Guideline Targets, and Population Percentiles: The Very Large Database of Lipids (VLDL-2 Study)
Background Worldwide guidelines recommend a Non-HDL-C target of <100 mg/dL (30 mg/dL above LDL-C target) in high risk patients only when triglycerides (TG) ≥200 mg/dL, although TG of 100 mg/dL is considered “optimal” and TG 150-200 mg/dL is considered “elevated”. The performance of the present guidelines-based TG criterion in identifying treatable dyslipidemia is largely unknown.
Methods We examined 1,340,614 U.S. adults in the Very Large Database of Lipids (VLDL). Lipid testing was performed by ultracentrifugation (Atherotech, Birmingham, AL). LDL-C was estimated by the Friedewald method, excluding patients with TG ≥400 mg/dL (2.3% of sample). We calculated the proportion of individuals reclassified using a population percentile based Non-HDL-C target versus the recommended target of <100 mg/dL.
Results The equivalent Non-HDL-C percentile to LDL-C of 70 mg/dL was 93 mg/dL. In those with LDL-C <70 mg/dL, 15% had a Non-HDL-C≥100 mg/dL while 30% had a Non-HDL-C≥90 mg/dL. Considerable reclassification occurred at TG levels of 100-199 mg/dL.
Conclusion If a population percentile based Non-HDL-C target of 90 mg/dL were used instead of the guideline mandated 100 mg/dL, twice as many patients with LDL-C <70 mg/dL would be eligible for treatment, including a considerable proportion of patients with TG <200mg/dL. More generalized use of population percentile based Non-HDL-C targets may be superior for secondary prevention at TG levels <200 mg/dL, with implications for guideline development.
- © 2013 by American Heart Association, Inc.