Current Atherosclerosis Reports

, Volume 14, Issue 2, pp 130–134 | Cite as

The Role of Non-HDL Cholesterol in Risk Stratification for Coronary Artery Disease

  • Jamal S. RanaEmail author
  • S. Matthijs Boekholdt
  • John J. P. Kastelein
  • Prediman K. Shah
Coronary Heart Disease (J Farmer, Section Editor)


Despite aggressive lipid-lowering therapy, patients continue to be at significant risk of coronary heart disease (CHD). Assessment of non–high-density lipoprotein cholesterol (non–HDL-C) provides a measure of cholesterol contained in all atherogenic particles. In the third Adult Treatment Panel (ATP III) guidelines of the US National Cholesterol Education Program, non–HDL-C was introduced as a secondary target of therapy in persons with triglycerides ≥200 mg/dL. A recent meta-analysis of the relationship between non–HDL-C reduction and CHD risk showed non–HDL-C as an important target of therapy for CHD prevention. Most lipid-modifying drugs used as monotherapy have a 1:1 relationship between percent non–HDL-C lowering and percent CHD reduction. In the EPIC-Norfolk prospective population study, 21,448 participants without diabetes or CHD between 45 and 79 years of age were followed for 11.0 years. Participants with high non–HDL-C levels were at increased CHD risk independently of their LDL-C levels. Also, compared to apolipoprotein B, non–HDL-C appears to be a better choice given the fact that no additional tests or costs are needed and established cut points are already available. Future guidelines should emphasize the importance of non–HDL-C for guiding cardiovascular prevention strategies with an increased need to have non–HDL-C reported on routine lipid panels.


Low-density lipoprotein cholesterol Non-HDL cholesterol Apolipoprotein B Coronary heart disease 



J.S. Rana: none; S.M. Boekholdt: none; J.J.P. Kastelein serves as a consultant for a number of pharmaceutical companies who have molecules in development for the treatment of dyslipidemia: Merck, Roche, Novartis, Isis, Genzyme, Aegerion, Cerenis, AstraZeneca, Sanofi-Aventis; P.K. Shah: none.


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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Jamal S. Rana
    • 1
    • 3
    Email author
  • S. Matthijs Boekholdt
    • 2
  • John J. P. Kastelein
    • 2
  • Prediman K. Shah
    • 1
  1. 1.Division of Cardiology and Oppenheimer Atherosclerosis Research CenterCedars-Sinai Heart Institute, Cedars-Sinai Medical CenterLos AngelesUSA
  2. 2.Department of Vascular Medicine, Academic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands
  3. 3.Department of CardiologyCedars-Sinai Heart Institute, Cedars-Sinai Medical CenterLos AngelesUSA

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