A Proposal for the Optimal Management Target for Serum Non-High-Density Lipoprotein Cholesterol Level in Low-Risk Japanese Workers
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AIM: The Japan Atherosclerosis Society Guidelines for the Diagnosis and Prevention of Atherosclerotic Cardiovascular Diseases 2012 (JAS Guidelines 2012) indicate that the management target for serum non-high-density lipoprotein cholesterol (non-HDLC) level is 30 mg/dL higher than that for low-density lipoprotein cholesterol (LDLC) level. However, it remains unclear whether this value is applicable to subjects at a low risk of cardiovascular disease. This study aimed to propose the optimal management target for serum non-HDLC level in low-risk Japanese subjects. METHODS: Among 20,909 subjects who underwent annual medical checkup at a Japanese company in 2008, we analyzed the data of 17,023 subjects (14,352 men, mean age 37.8±8.6 years) in risk category I according to the JAS Guidelines 2012. The correlation between LDLC and non-HDLC levels was examined. RESULTS: A strong correlation was found between LDLC and non-HDLC levels (r=0.95, p<0.001). The following regression equation for calculation of non-HDLC was obtained from linear regression analysis: non-HDLC (mg/dL)=1.09×LDLC (mg/dL)＋7.79. According to this equation, the optimal management target for non-HDLC level corresponding to that for LDLC level (160 mg/dL) was 180 mg/dL. A multiple logistic regression analysis revealed that age, obesity, habitual alcohol intake, and current smoking were significantly associated with non-HDLC ≥180 mg/dL. CONCLUSIONS: The management target for non-HDLC level is recommended to be set at 20 mg/dL higher than that for the LDLC level (i.e., 180 mg/dL) in low-risk Japanese subjects.
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A meta-analysis of randomized controlled trials involving the use of statins revealed that a 20-30% decrease in LDL-C level lowers the risk for CAD by approximately 30%.
“The results of a meta-analysis of randomized controlled trials involving the use of statins revealed that a 20–30% decrease in LDL-C level lowers the risk for CAD by approximately 30%347, 348).”
From Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017 (2018) · cites this paper as [348]
A decrease in the incidence of cardiovascular events is proportionate to the decrease in LDL-C level, regardless of pretreatment LDL-C level and individual absolute risk.
“Meta-analyses conducted by the Cholesterol Treatment Trialists' Collaboration on large-scale clinical trials using statins confirmed that a decrease in the incidence of cardiovascular events was proportionate to the decrease in LDL-C level, regardless of pretreatment LDL-C level and individual absolute risk177–179, 348).”
From Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017 (2018) · cites this paper as [348]
Statin therapy may prevent the development of cerebral infarction.
“Statin therapy may prevent the development of cerebral infarction. (Evidence level: 2, recommendation level: A)”
From Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017 (2018) · cites this paper as [348]
The results of a meta-analysis of prevention studies on CAD did not indicate that cholesterol-lowering therapy leads to an increased cerebral hemorrhage incidence.
“However, as described later, the results of a meta-analysis of prevention studies on CAD did not indicate that cholesterol-lowering therapy leads to an increased cerebral hemorrhage incidence348).”
From Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017 (2018) · cites this paper as [348]
Regarding the results of SPARCL, which are contrary to those of a meta-analysis, it has been shown that hemorrhage incidence does not increase in the Japanese.
“Moreover, in regard to the results of SPARCL, which are contrary to those of a meta-analysis348) in which increased incidence of cerebral hemorrhage because of statin administration was not observed, it has been shown that hemorrhage incidence does not increase in the Japanese.”
From Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017 (2018) · cites this paper as [348]
In that meta-analysis, cerebral hemorrhage incidence did not change significantly with statin therapy.
“On the other hand, cerebral hemorrhage incidence did not change significantly348).”
From Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017 (2018) · cites this paper as [348]
The results of a meta-analysis of prevention studies conducted in western countries showed that cholesterol-lowering therapy using statins significantly decreased cerebral infarction incidence by 19%.
“The results of a meta-analysis of prevention studies conducted in the western counties showed that cholesterol-lowering therapy using statins significantly decreased cerebral infarction incidence by 19%.”
From Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017 (2018) · cites this paper as [348]
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- Authors
- Saiki, Y., Otsuka, T., Kato, K., & Kawada, T.
- Affiliations
- Nippon Medical School (JP)
- Chiba Hokusou Hospital (JP)
- Venue
- Journal of Atherosclerosis and Thrombosis
- Publisher
- Japan Atherosclerosis Society
- Published
- 2016
- Volume
- 23
- Issue
- 4
- Pages
- 422-430
- ISSN
- 1340-3478 (ISSN-L)
- 1880-3873
- OpenAlex
- W2324417830
- Cited by
- 7
- References
- 29
- Citations by year
- 2024: 1 · 2023: 1 · 2019: 1 · 2018: 3 · 2016: 1
- FWCI
- 1.84
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- cc-by-nc-sa
- Locations
- Journal of Atherosclerosis and Thrombosis (publishedVersion, cc-by-nc-sa)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Keywords
- non-HDL cholesterol, LDL cholesterol, low cardiovascular risk, Japanese workers, atherosclerotic cardiovascular disease prevention, risk factors, obesity, alcohol consumption, smoking
- MeSH terms
- Adolescent, Adult, Cardiovascular Diseases, Cholesterol, Female, Health Promotion, Humans, Japan, Lipoproteins, HDL, Cholesterol, LDL, Male, Middle Aged, Regression Analysis, Risk Factors, Occupational Health, Disease Management, Atherosclerosis, Young Adult
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