What a relevant question.
Is non-HDL cholesterol adequate, or do we need to measure apolipoprotein B to assess cardiovascular risk. This paper addresses that question. I liked the subheading “do the Math”
It starts by reminding us that current guidelines rely on LDL-C as the primary therapeutic target in the prevention of cardiovascular disease. They go on to point out the limitations of LDL. Only 30% reduction in ACS and less predictive value in the metabolic syndrome which is becoming increasingly prevalent. The metabolic syndrome may increase VLDL and other lipoproteins which are atherogenic, but not accounted for by LDL-C alone. The Apolipoprotein B seems like a likely candidate, since it seems to be associated with most atherogenic particles, therefore giving an aggregate number of all atherogenic particles.
A simple way of doing this may be non-HDL cholesterol which is the Total Cholesterol (TC) minus the HDL (HDL-C) [TC-HDL-C]. An interesting question is the comparison of apo-B to non-HDL cholesterol. This paper rightfully points out the significant high correlation of the two variables, and the inability of apo-B to independently outperform non-HDL cholesterol.
The concluding remarks compare and contrast apo-B with non-HDL cholesterol and leads to my same conclusion:
“Non-HDL cholesterol is a more realistic primary target of therapy, given its ease of use and implementation”
1. Non–High-Density Lipoprotein Cholesterol Versus Apolipoprotein B in Cardiovascular Risk Stratification doi:10.1016/j.jacc.2011.05.009 J Am Coll Cardiol 2011;58:457–63
Bryan E Fuhs MD reviewed 9/2/2011