Non-high-density lipoprotein cholesterol outperforms low-density lipoprotein cholesterol in predicting cardiovascular...

Non-high-density lipoprotein cholesterol (non-HDL-C) has been reported to exhibit stronger associations with cardiovascular (CV) outcomes compared to low-density lipoprotein cholesterol (LDL-C). However, data on this association, particularly among Asians using statins, are limited. This study aimed to compare the predictability of non-HDL-C and LDL-C on long-term 3-point major adverse cardiac events (3P-MACE) in statin-treated patients.

Data from patients with atherosclerotic cardiovascular disease (ASCVD) or at high risk were obtained from the multicenter national registry, "CORE-Thailand study." The primary outcome was 3P-MACE, including all-cause mortality, nonfatal myocardial infarction, and nonfatal stroke. Patients were stratified into quartiles based on non-HDL-C and LDL-C levels, and Cox proportional hazards regression models were used to analyze their association with 3P-MACE.

A total of 6978 with non-HDL-C data and 7365 with LDL-C data were included. In the fully adjusted model, overall non-HDL-C data and data from the highest quartile showed a significant association with 3P-MACE (hazard ratio [HR]: 1.008, 95% CI, 1.003-1.012, P < .001 and HR: 1.676, 95% CI, 1.218-2.307, P = .002, respectively). LDL-C did not exhibit a significant association with 3P-MACE. Interestingly, there was a trend suggesting that higher LDL-C levels were associated with a reduced risk of long-term MACE when adjusted for non-HDL-C. These findings were consistent across all population subgroups.

In patients with high-risk or established ASCVD receiving statin therapy, elevated non-HDL-C, rather than LDL-C, was associated with 3P-MACE. Non-HDL-C may therefore be considered a primary target for addressing residual CV risk in these individuals.

TCTR20130520001 registered in Thai Clinical Trials Registry (TCTR) https://www.thaiclinicaltrials.org/, date of registration 20 May 2013.