Non-HDL-cholesterol and apolipoprotein B compared with LDL-cholesterol in atherosclerotic cardiovascular disease risk...

Area of Science:

• Cardiovascular Medicine
• Lipidology
• Clinical Chemistry

Background:

• Low-density lipoprotein (LDL) cholesterol is a primary target for atherosclerotic cardiovascular disease (ASCVD) risk assessment.
• Traditional fasting lipid profiles and the Friedewald equation for estimating LDL cholesterol have limitations, including issues with non-fasting samples and hypertriglyceridemia.
• Direct LDL cholesterol measurements lack standardization, and non-high-density lipoprotein (HDL) cholesterol calculations can be affected by HDL measurement variability.

Purpose of the Study:

• To compare the utility of non-high-density lipoprotein (HDL)-cholesterol and apolipoprotein B (apoB) against low-density lipoprotein (LDL)-cholesterol for atherosclerotic cardiovascular disease (ASCVD) risk assessment.
• To review the measurement, role, and current status of non-HDL-cholesterol and apoB in clinical practice.
• To highlight the advantages of non-HDL-cholesterol and apoB in specific patient populations and sample conditions.

Main Methods:

• Review of existing literature on lipid measurement techniques and their association with ASCVD risk.
• Comparison of LDL-cholesterol, non-HDL-cholesterol, and apoB in terms of accuracy and clinical utility.
• Evaluation of performance in various clinical scenarios, including non-fasting samples, hypertriglyceridemia, and very low LDL-cholesterol levels.

Main Results:

• Non-HDL-cholesterol and apoB are more accurate than LDL-cholesterol in hypertriglyceridemic individuals, non-fasting samples, and those with very-low LDL-cholesterol.
• Apolipoprotein B (apoB) methods are standardized and measure atherogenic lipoprotein particle number.
• Accumulating evidence indicates non-HDL-cholesterol and apoB are superior to LDL-cholesterol in predicting ASCVD risk.

Conclusions:

• Non-HDL-cholesterol and apoB demonstrate superior performance over LDL-cholesterol in predicting ASCVD risk, particularly in challenging clinical scenarios.
• Both non-HDL-cholesterol and apoB are increasingly recognized as valuable secondary targets in ASCVD prevention guidelines.
• Further adoption of non-HDL-cholesterol and apoB can enhance the accuracy of cardiovascular risk assessment.