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Discordance identified between LDL, non-HDL percentiles
A new analysis of 1.3 million individuals highlights the magnitude of patient-level discordance between LDL and non-HDL percentiles.
According to the report, there is significant discordance between LDL and non-HDL percentiles at lower LDL and higher triglyceride levels.
In the study, Mohamed B. Elshazly, MD, and colleagues wrote: “Current non-HDL cutpoints for high-risk patients may need to be lowered to match percentiles of LDL cutpoints. Relatively small absolute reductions in non-HDL cutpoints result in substantial reclassification of patients to higher treatment categories with potential implications for risk assessment and treatment.”
The researchers investigated whether non-HDL goals should be used at the same population percentiles as LDL goals, as suggested by previous research. They examined lipid profiles of 1,310,440 US adults (mean age, 59 years; 52% women) included in the Very Large Database of Lipids. Participants had triglyceride levels of less than 400 mg/dL and underwent lipid testing by vertical spin density gradient ultracentrifugation (Atherotech) from 2009 to 2011.
Because current guidelines recommend using non-HDL as a secondary treatment target after the LDL target is reached, the researchers focused on those who would be reclassified within a higher treatment category based on non-HDL.
The researchers determined that LDL cutpoints of 70 mg/dL, 100 mg/dL, 130 mg/dL, 160 mg/dL and 190 mg/dL corresponded with the same population percentiles of the non-HDL values of 93 mg/dL, 125 mg/dL, 157 mg/dL, 190 mg/dL and 223 mg/dL.
Non-HDL values reclassified a significant proportion of those within a higher treatment category, when compared with Friedewald-estimated LDL levels. This association was particularly strong at triglyceride levels of at least 150 mg/dL and LDL levels in the treatment range of high-risk patients, according to the study abstract.
Among those with LDL levels less than 70 mg/dL, 15% had a non-HDL value of at least 100 mg/dL, the cutpoint recommended by guidelines, but 25% had a non-HDL level of at least 93 mg/dL, the cutpoint based on percentile. The percentages increased to 22% and 50%, respectively, if triglycerides were 150 mg/dL to 199 mg/dL concurrently, according to the abstract.
Percentiles of LDL and non-HDL “are most discordant when accuracy is most crucial, at low LDL and high triglycerides,” the researchers wrote. “Therefore, conventional non-HDL cutpoints for high-risk patients may need to be lowered to match percentiles of LDL cutpoints.”
The researchers recommended that non-HDL cutpoints be lowered by 5 mg/dL in the high-risk category and by 7 mg/dL in the very high-risk category.
Disclosure: See the full study for a list of the researchers’ relevant financial disclosures.