Miller Michael, Ginsberg Henry N, Schaefer Ernst J
Division of Cardiology, University of Maryland Medical Center, Baltimore, MD, USA.
Am J Cardiol. 2008 Apr 1;101(7):1003-8. doi: 10.1016/j.amjcard.2007.11.046.
Although low-density lipoprotein cholesterol (LDL-C) is a well-established atherogenic factor for coronary heart disease, it does not completely represent the risk associated with atherogenic lipoproteins in the presence of high triglyceride (TG) levels. Constituent lipoproteins constituting non-high-density lipoprotein cholesterol (non-HDL-C) include atherogenic TG-rich lipoproteins, cholesteryl ester-enriched remnants of TG-rich lipoproteins, and lipoprotein(a). Recent observational and intervention studies suggest that the predictive value of non-HDL-C for cardiovascular risk and mortality is better than low-density lipoprotein cholesterol and that non-HDL-C correlates highly with plasma apolipoprotein B levels. Currently, the National Cholesterol Education Program Adult Treatment Panel III guidelines identify non-HDL-C as a secondary target of therapy in patients with TG elevation (> or =200 mg/dl) after the attainment of LDL-C target goals. In patients with coronary heart disease or coronary heart disease risk equivalents, an optional non-HDL-C goal is <100 mg/dl. To achieve the non-HDL-C goal, statin therapy may be intensified or combined with ezetimibe, niacin, a fibrate, or omega-3 fatty acids. In conclusion, non-HDL-C remains an important target of therapy for patients with elevated TGs, although its widespread adoption has yet to gain a foothold among health care professionals treating patients with dyslipidemia.
尽管低密度脂蛋白胆固醇（LDL-C）是冠心病公认的致动脉粥样硬化因子，但在高甘油三酯（TG）水平存在时，它并不能完全代表与致动脉粥样硬化脂蛋白相关的风险。构成非高密度脂蛋白胆固醇（non-HDL-C）的脂蛋白成分包括富含TG的致动脉粥样硬化脂蛋白、富含胆固醇酯的富含TG脂蛋白残余物以及脂蛋白（a）。最近的观察性和干预性研究表明，non-HDL-C对心血管风险和死亡率的预测价值优于低密度脂蛋白胆固醇，且non-HDL-C与血浆载脂蛋白B水平高度相关。目前，美国国家胆固醇教育计划成人治疗小组第三次指南将non-HDL-C确定为TG升高（≥200mg/dl）患者在达到LDL-C目标后治疗的次要靶点。对于患有冠心病或冠心病风险等同症的患者，non-HDL-C的可选目标是<100mg/dl。为实现non-HDL-C目标，可强化他汀类药物治疗或与依泽替米贝、烟酸、贝特类药物或ω-3脂肪酸联合使用。总之，non-HDL-C仍然是TG升高患者治疗的重要靶点，尽管它在治疗血脂异常患者的医护人员中尚未广泛应用。
