Discordance between non-HDL cholesterol and LDL cholesterol levels in patients with diabetes without previous cardiovascular events.

OBJECTIVES

Despite achieving desirable LDL cholesterol levels, the residual cardiovascular (CV) risk remains high among patients with diabetes. This is partly due to the increased number of atherogenic LDL particles and apoB levels, despite optimal LDL levels. As correlation studies have shown that non-HDL cholesterol is an acceptable surrogate marker for apoB, this study aimed to determine the concordance between non-HDL and LDL cholesterol in diabetic patients with different triglyceride and HbA(1c) levels and metabolic syndrome (MS) status.

METHODS AND RESULTS

Data from 11,005 diabetes patients from a large UK primary-care electronic database, with no previous CV events and not taking lipid-lowering therapy, were analyzed. Of the patients with LDL cholesterol <1.8 mmol/L, only 58.6% had correspondingly low levels of non-HDL cholesterol (< 2.6 mmol/L). Concordance between very low LDL and very low non-HDL values was significantly less among patients with high triglycerides (25.5%) compared with those with low triglycerides (76.2%) (Pearson's χ(2) test=177.6; P<0.001). However, greater concordance between very low LDL and very low non-HDL cholesterol levels was seen in patients without (77.9%), compared with those with (50.3%), the MS (Pearson's χ(2) test=59.7; P<0.001). This persisted even after adjusting for hypertriglyceridaemia. Concordance was similar at different levels of glycaemia.

CONCLUSION

There was a significant discordance between LDL and non-HDL cholesterol levels in diabetes patients with high triglycerides or the MS. This might explain patients' high residual CV risk despite having achieved their desirable LDL cholesterol levels. Thus, treating both non-HDL and LDL cholesterol to achieve target values should be considered to reduce residual CV risk in patients with diabetes.