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Non-HDL-cholesterol shows improved accuracy for cardiovascular risk score classification compared to direct or calculated LDL cholesterol in a dyslipidemic population
Open accessAbstract
BACKGROUND: Our objective was to evaluate the accuracy of cardiovascular disease (CVD) risk score classification by direct LDL cholesterol (dLDL-C), calculated LDL cholesterol (cLDL-C), and non–HDL cholesterol (non–HDL-C) compared to classification by reference measurement procedures (RMPs) performed at the CDC. METHODS: We examined 175 individuals, including 138 with CVD or conditions that may affect LDL-C measurement. dLDL-C measurements were performed using Denka, Kyowa, Sekisui, Serotec, Sysmex, UMA, and Wako reagents. cLDL-C was calculated by the Friedewald equation, using each manufacturer's direct HDL-C assay measurements, and total cholesterol and triglyceride measurements by Roche and Siemens (Advia) assays, respectively. RESULTS: For participants with triglycerides <2.26 mmol/L (<200 mg/dL), the overall misclassification rate for the CVD risk score ranged from 5% to 17% for cLDL-C methods and 8% to 26% for dLDL-C methods when compared to the RMP. Only Wako dLDL-C had fewer misclassifications than its corresponding cLDL-C method (8% vs 17%; P < 0.05). Non–HDL-C assays misclassified fewer patients than dLDL-C for 4 of 8 methods (P < 0.05). For participants with triglycerides ≥2.26 mmol/L (≥200 mg/dL) and <4.52 mmol/L (<400 mg/dL), dLDL-C methods, in general, performed better than cLDL-C methods, and non–HDL-C methods showed better correspondence to the RMP for CVD risk score than either dLDL-C or cLDL-C methods. CONCLUSIONS: Except for hypertriglyceridemic individuals, 7 of 8 dLDL-C methods failed to show improved CVD risk score classification over the corresponding cLDL-C methods. Non–HDL-C showed overall the best concordance with the RMP for CVD risk score classification of both normal and hypertriglyceridemic individuals.
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“As a result, under most circumstances, they provide very similar information about ASCVD risk [45,105-108].”
From 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk (2019) · cites this paper as [107]
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“Despite this limitation, non-HDLC yields more accurate cardiovascular risk classification than either Friedewald cLDLC or dLDLC, and also more consistent risk scores using different manufacturers' assays for dHDLC in the calculation [58].”
From Quantifying atherogenic lipoproteins for lipid-lowering strategies: Consensus-based recommendations from EAS and EFLM (2020) · cites this paper as [58]
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“In general, LDL-C, non-HDL-C, and ApoB concentrations are very highly correlated.”
From 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk (2019) · cites this paper as [107]
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Metadata
- Authors
- van Deventer, H. E., Miller, W. G., Myers, G. L., Sakurabayashi, I., Bachmann, L. M., Caudill, S. P., Dziekonski, A., Edwards, S., Kimberly, M. M., Korzun, W. J., Leary, E. T., Nakajima, K., Nakamura, M., Shamburek, R. D., Vetrovec, G. W., Warnick, G. R., & Remaley, A. T.
- Affiliations
- National Institutes of Health, Bethesda, MD
- Virginia Commonwealth University (US)
- Centers for Disease Control and Prevention (US)
- Jichi Medical University (JP)
- Virginia Commonwealth University, Richmond, VA
- Pacific Biomarkers (United States) (US)
- Otsuka (Japan) (JP)
- Osaka Medical Center for Health Science and Promotion, Osaka, Japan
- National Institutes of Health (US)
- Health Diagnostics Laboratory, Richmond, VA
- Corresponding author
- Remaley, Alan T
- ORCID
- Venue
- Clinical Chemistry
- Publisher
- Oxford University Press (OUP)
- Published
- 2011-03-01
- Volume
- 57
- Issue
- 3
- Pages
- 490-501
- ISSN
- 0009-9147 (ISSN-L)
- 1530-8561
- PMC
- PMC4684263
- OpenAlex
- W2158071129
- Cited by
- 112
- References
- 39
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 6 · 2023: 10 · 2022: 5 · 2021: 3 · 2020: 9 · 2019: 8 · 2018: 12 · 2017: 10 · 2016: 6 · 2015: 6 · 2014: 9 · 2013: 6 · 2012: 9
- FWCI
- 9.50
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- Clinical Chemistry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Genzyme
- Pointe Scientific
- Pacific Biometrics Research Foundation provided
- Virginia Commonwealth University
- National Institutes of Health
- Warren Grant Magnuson Clinical Center
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipoproteins and Cardiovascular Health
- Health Sciences › Health Professions › Medical Laboratory Technology › Clinical Laboratory Practices and Quality Control
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- non-HDL cholesterol, LDL cholesterol, cardiovascular risk score, dyslipidemia, Friedewald formula, hypertriglyceridemia, assay comparison, reference measurement procedure, misclassification rate
- MeSH terms
- Blood Chemical Analysis, Cardiovascular Diseases, Data Interpretation, Statistical, Fasting, Humans, Cholesterol, HDL, Cholesterol, LDL, Risk Factors, Sensitivity and Specificity, Triglycerides, Ultracentrifugation, Reproducibility of Results, Case-Control Studies, Risk Assessment, Dyslipidemias
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