Non-High-Density Lipoprotein Cholesterol and Guidelines for Cholesterol Lowering in Recent History

Area of Science:

• Clinical Biochemistry
• Cardiovascular Medicine
• Health Policy

Background:

• The National Cholesterol Education Program (NCEP) has periodically updated cholesterol treatment guidelines since 1988.
• Guidelines were released in 1988, 1994, 2002, and then more frequently from 2013 to 2018.

Purpose of the Study:

• To review the evolution of NCEP cholesterol guidelines.
• To explain the rationale behind recommended treatment targets.
• To highlight the significance of non-high-density cholesterol (non-HDLC) in risk assessment and treatment.

Main Methods:

• Review of NCEP cholesterol treatment guidelines from 1988 to 2018.
• Discussion of factors influencing guideline development and changes.
• Explanation of biochemical mechanisms and pathophysiology of beta-lipoproteins.
• Focus on non-HDLC as a risk marker and treatment target.

Main Results:

• The 2017 and 2018 guidelines extended previous recommendations.
• Non-HDLC is presented as equivalent to low-density lipoprotein cholesterol (LDLC) for treatment targets.
• Non-HDLC demonstrates advantages over LDLC in assessing cardiovascular risk.

Conclusions:

• Recent NCEP guidelines support non-HDLC as a valuable metric for cholesterol management.
• Laboratory reports should incorporate non-HDLC values and associated cutoffs.
• Non-HDLC offers a more comprehensive approach to cardiovascular risk assessment and treatment.