non-HDL-C: The missing parameter in primary care

Area of Science:

• Cardiology
• Metabolic Health
• Public Health

Background:

• Non-high-density lipoprotein cholesterol (non-HDL-C) is a key indicator of cardiovascular risk.
• Elevated non-HDL-C is associated with metabolic diseases, but its prevalence and predictive value for new diagnoses in the general population require further investigation.

Purpose of the Study:

• To determine the prevalence of elevated non-HDL-C in a large, general population without lipid-lowering drug treatment.
• To analyze the association between elevated non-HDL-C and existing metabolic diseases.
• To assess the risk of developing new metabolic diseases in individuals with elevated non-HDL-C.

Main Methods:

• Analysis of electronic health records from 820,318 subjects with at least two lipid measurements between 2012-2016.
• Definition of elevated non-HDL-C as > LDL-C + 30 mg/dL on two consecutive occasions.
• Propensity score matching was used to compare 5-year outcomes between subjects with elevated non-HDL-C and controls.

Main Results:

• 101,939 subjects (12.4%) had elevated non-HDL-C.
• Elevated non-HDL-C was more prevalent in individuals with type 2 diabetes, hypertension, obesity, NASH, CKD, and cardiovascular disease.
• Elevated non-HDL-C significantly increased the risk of new diagnoses for diabetes (HR 2.53), hypertension (HR 1.37), and MASLD (HR 1.37).

Conclusions:

• Elevated non-HDL-C is a significant risk marker for metabolic diseases.
• Routine assessment and monitoring of non-HDL-C during lipid testing are recommended for improved management of metabolic health.
• Non-HDL-C monitoring can aid in the early identification and prevention of new metabolic disease diagnoses.