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

To assess the prevalence of elevated non-HDL-C values in the general population in the absence of lipid-lowering drugs. Association with metabolic diseases and the risk to develop new ones were analyzed using data from electronic health records.

820,318 subjects with at least two lipid measurements between 2012 and 2016, and without lipid-lowering drug treatment, were included. Once selected, non-HDL-C and LDL-C + 30 were calculated, with non-HDL-C being defined as elevated if it was higher than LDL-C + 30 mg (4.00 mmol) on two consecutive occasions. The prevalence of metabolic diseases in subjects with or without elevated non-HDL-C was assessed. Subjects with elevated non-HDL-C and an equal number of controls, selected using propensity score matching, were observed for five years, during which time new diagnoses of diseases with a metabolic component were evaluated.

101,939 subjects have elevated non-HDL-C more prevalent in patients with type 2 diabetes, hypertension, obesity, steatohepatitis (NASH), chronic kidney disease (CKD) and cardiovascular disease. During follow-up, new diagnoses of diabetes (hazard ratio (HR) 2.529, 95% confidence interval (CI) 2.392-2.672), hypertension (HR 1.365, 95% CI 1.286-1.450) and MASLD (HR 1.365, 95% CI 1.286-1.450) were associated with elevated non-HDL-C levels, as assessed using Cox models that included age, sex, triglycerides, LDL-C and non-HDL-C as covariates.

Non-HDL-C assessment and monitoring should be included in routine healthcare and evaluated during lipid testing, since it is a risk marker that requires monitoring to improve control of metabolic diseases.