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Non-HDL Cholesterol and Residual Cardiometabolic Risk in Middle Eastern Patients with Atherosclerotic Cardiovascular
Osama Alkouri1, Ahmad M Al-Bashaireh2, Alanoud Alobaidly3
1Faculty of Nursing, Yarmouk University, P.O. Box 566, Irbid 21163, Jordan.
Insights
Elevated non-HDL cholesterol is common in Middle Eastern patients with atherosclerotic cardiovascular disease (ASCVD), particularly younger individuals. This indicates early metabolic risk and supports non-HDL-C as a valuable marker for residual cardiovascular risk assessment.
Area of Science:
- Cardiology
- Metabolic Disorders
- Public Health
Background:
- Low-density-lipoprotein cholesterol (LDL-C) is the primary lipid target, but residual risk persists in atherosclerotic cardiovascular disease (ASCVD) patients.
- Non-high-density lipoprotein cholesterol (non-HDL-C) and cholesterol ratios may offer a more comprehensive atherogenic risk assessment.
- Metabolic disorders are prevalent in Middle Eastern populations, necessitating evaluation of alternative lipid markers.
Purpose of the Study:
- To assess the prevalence of elevated non-HDL-C and adverse cholesterol ratios in Middle Eastern ASCVD patients.
- To identify clinical determinants associated with elevated non-HDL-C in this population.
- To evaluate the role of non-HDL-C in reflecting residual cardiovascular risk.
Main Methods:
- Pooled cross-sectional analysis of 2763 adults with confirmed ASCVD from the Jordan SMuRF-less Study and Middle Eastern cardiovascular registries.
- Stratification by standard modifiable cardiovascular risk factors (SMuRFs).
- Harmonized demographic, clinical, treatment, and lifestyle data analyzed using multivariable regression models.
Main Results:
- 54% of patients had elevated non-HDL-C, more common in younger individuals and current smokers.
- Elevated non-HDL-C was associated with higher baseline LDL-C and triglycerides.
- Age > 60, hypertension, and heart failure were inversely associated with elevated non-HDL-C.
Conclusions:
- Elevated non-HDL cholesterol is prevalent in Middle Eastern ASCVD patients, signifying early metabolic risk.
- Non-HDL-C serves as a crucial marker for residual cardiovascular risk.
- Findings support earlier screening and tailored prevention strategies for this population.
Abstract:
Background: Although low-density-lipoprotein cholesterol (LDL-C) remains the primary target of lipid-lowering therapy, many patients with atherosclerotic cardiovascular disease (ASCVD) continue to experience cardiovascular events. This residual risk suggests that LDL-C alone does not fully capture the total atherogenic burden. Alternative lipid measures, including non-high-density lipoprotein cholesterol (non-HDL-C) and cholesterol ratios, may provide a more comprehensive risk assessment, particularly in populations with a high prevalence of metabolic disorders. This study assessed the prevalence and clinical determinants of elevated non-HDL cholesterol and adverse cholesterol ratios among Middle Eastern patients with established ASCVD. Methods: This pooled cross-sectional analysis included 2763 adults with confirmed ASCVD from the Jordan SMuRF-less Study and six cardiovascular registries across the Middle East. Patients were stratified by standard modifiable cardiovascular risk factors (SMuRFs). Demographic, clinical, treatment, and lifestyle data were harmonized and analyzed using multivariable regression models. Results: Elevated non-HDL-C was observed in 54% of patients. Those with elevated non-HDL-C were younger (55.0 vs. 59.9 years) and more frequently current smokers (52.6% vs. 43.1%). Hypertension (64.2% vs. 51.0%) and heart failure (25.0% vs. 15.4%) were more common among patients with lower non-HDL-C, whereas dyslipidemia (90.8% vs. 75.8%) and acute coronary syndrome (88.1% vs. 83.7%) were more prevalent in the elevated group. Elevated non-HDL-C was associated with higher baseline LDL-C levels measured prior to the initiation of lipid-lowering therapy (141.3 vs. 81.1 mg/dL) and higher triglycerides (221.4 vs. 140.9 mg/dL). In multivariable analyses, age > 60 years (OR = 0.45), hypertension (OR = 0.74), and heart failure (OR = 0.61) were inversely associated with elevated non-HDL-C. Conclusions: Elevated non-HDL cholesterol is common among Middle Eastern patients with ASCVD, particularly younger individuals, reflecting early metabolic risk and increased atherogenic burden. Non-HDL-C is a valuable marker of residual cardiovascular risk, supporting earlier screening and region-specific prevention strategies.
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