Czy nie-HDL cholesterol lepiej niż cholesterol frakcji LDL odzwierciedla ryzyko sercowo-naczyniowe?

Abstract

The concentration of lipids and lipoproteins in plasma is essential in the treatment of lipid disorders. The routine lipid panel includes total cholesterol, triglycerides, cholesterol of low-density lipoprotein (LDL-C) and cholesterol of high- -density lipoprotein (HDL-C). The latest guidelines of the European Society of Cardiology (valid until 2020) indicate that besides many players in the lipid arena (apolipoprotein, concentration and size of LDL particles) another parameter, non-HDL-cholesterol (non-HDL-C), is very important. This parameter, being easily available for routine clinical use, has been highlighted as a key secondary goal of therapy in patients with cardiometabolic risk. Non-HDL-C is a superior parameter to LDL-C, especially the one estimated using Friedewald formula for prediction of cardiovascular events, because non-HDL-C is an integrated complex of all lipoprotein particles containing apolipoprotein B, i.e.: LDL, very low-density lipoproteins, intermediate-density lipoproteins, chylomicrons, remnants and Lp(a). Crucially, it can be calculated directly from the values of routine lipid panels, without additional cost. In our opinion, non-HDL-C should be presented in all routine lipid profiles conducted by diagnostic laboratories. We also propose a new presentation of the results of routine lipid panel, which allows a significant change in treatment goals, taking into account the hierarchy of values of individual concentrations of lipoprotein fractions and how they are interpreted in the management of dyslipidaemia for optimal prevention of atherosclerosis and cardiovascular diseases.