“Really Bad” Cholesterol and Heart Risk By Paula Rasich Reviewed by Elizabeth Klodas, MD, FACC  A risk factor called “non-HDL cholesterol” probably isn’t part of your routine lipid profile, but there’s good reason it should be. In fact, studies are showing that non-HDL may predict heart disease risk better than “bad” LDL cholesterol.

Non-HDL is a measurement of not only LDL, but also a whole host of other potentially dangerous  blood fat particles that tend to cause damage to artery walls. New research suggests that getting a true understanding of your heart health requires knowing your non-HDL number.

To determine the relationship between non-HDL reduction and heart disease risk, researchers from the University of Iowa and elsewhere looked at data from 21 cholesterol-lowering trials. In this meta-analysis of more than 121,000 patients taking various cholesterol medications, researchers found that for every 1-point drop in non-HDL levels, the risk of heart disease declined by 1%.

Cholesterol lowering medications include statins (such as simvastatin, Lipitor® and Crestor®) as well as fibrates (such as gemfibrozil and Tricor®) and niacin. Statins are especially good at reducing LDL and fibrates are used mainly to lower triglycerides and help raise “good” HDL. Niacin (a vitamin) can be used in high doses to lower LDL, raise HDL and lower triglycerides.  Although optimal in overall effects on the cholesterol profile, widespread use of niacin has been limited by frequent side effects.

 “There is a very consistent relationship between how much non-HDL cholesterol is lowered and the risk of coronary heart disease is reduced, and it doesn’t matter whether you use a statin or a fibrate,” says lead study author Jennifer G. Robinson, MD, MPH, director of the Lipid Research Clinic at the University of Iowa. “This research shows that we have a better [test] to identify those [patients] whose arteries are really deteriorating.”

 So knowing your non-HDL number could help you better understand your risk for heart disease. To figure out your non-HDL number, simply subtract your HDL cholesterol number from your total cholesterol value. 

Editor’s Comment:  Revised national guidelines recommend a non-HDL level under 100 for people with known coronary artery disease and those with diabetes.  Aiming for a level below 130 is recommended for individuals with multiple risk factors for heart disease.

The study findings are published in the January 27, 2009 issue of the Journal of the American College of Cardiology.

Sources:

Robinson JG et al.  Meta-Analysis of the Relationship Between Non—High-Density Lipoprotein Cholesterol Reduction and Coronary Heart Disease Risk. Journal of the American College of Cardiology, 2008. 

Jennifer Robinson, MD, MPH, Associate Professor of Epidemiology and Medicine, Director of the Lipid Research Clinic at the University of Iowa, Iowa City, Iowa.