Non-high-density lipoprotein cholesterol as a cardiovascular risk screening tool in children

Non-high-density lipoprotein cholesterol (non-HDL-C) is now recognized as a strong predictive factor for cardiovascular disease in adults, but there have been few reports on non-HDL-C in children.

A total of 5853 4th and 7th grade schoolchildren were included in the screening for lifestyle-related disease from 2010 to 2011 in Takaoka City. The children underwent anthropometric measurements and non-fasting blood tests to measure total cholesterol (TC), HDL-C, triglyceride (TG), and low-density lipoprotein cholesterol (LDL-C). The relationship between percent overweight and each lipid level was analyzed, and children above the 97th percentile level with respect to both TC (220 mg/dL) and non-HDL-C (152 mg/dL) were compared and assessed. The relationship between non-HDL-C and the prevalence of metabolic syndrome was also analyzed among 150 obese children.

Non-HDL-C positively correlated with percent overweight and TG rather than did TC (r = 0.273, 0.360 vs 0.118, 0.179, all P < 0.001). In the screening using TC criteria, several subjects with increased HDL-C were miscategorized as hyperlipidemic, whereas none were miscategorized using the non-HDL-C criteria. The sensitivity of the identification of increased LDL-C was lower when the criteria for TC were used rather than the criteria for non-HDL-C (80.8% vs 98.3%). Among obese children, the prevalence of metabolic syndrome increased significantly and was accompanied by an increase in non-HDL-C (P = 0.009).

Instead of TC, non-HDL-C would serve as a better and useful cardiovascular risk screening tool for lifestyle-related disease in school children.