The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA.
J Clin Lipidol. 2008 Aug;2(4):267-73. doi: 10.1016/j.jacl.2008.06.013. Epub 2008 Jun 28.
Plasma levels of lipids and lipoproteins are essential to the management of lipid disorders by generalists and by practitioners of the emerging specialty of clinical lipidology. The routine lipid panel consists of total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides. Several additional lipid parameters are emerging as potentially valuable adjuncts to the standard panel, including measurements of apolipoproteins and LDL particle size and concentration, but most of these serve mainly as research tools at present. One major exception is non-HDL-C, which is readily available for routine clinical use. This review outlines some of the numerous research studies that clearly establish the clinical utility and even preeminence of non-HDL-C as a comprehensive measure of atherogenic lipoproteins. Non-HDL-C was highlighted as a key secondary goal of therapy several years ago in the National Cholesterol Education Program Adult Treatment Panel III national lipid treatment guidelines and recently was further emphasized as a major goal of therapy in the consensus guidelines for lipoprotein management in patients with cardiometabolic risk from the American Diabetes Association and the American College of Cardiology. Non-HDL-C is superior to LDL-C for the prediction of cardiovascular events and has many other compelling advantages over LDL-C and other traditional lipid parameters. Importantly, it can be calculated directly from values in routine lipid panels, at no added expense. It is our opinion that non-HDL-C should be reported on all routine lipid profiles and used regularly in the management of dyslipidemia for optimal prevention of atherosclerosis and cardiovascular disease.
血浆脂质和脂蛋白水平对于普通医生和新兴临床脂质学专业医生的脂质紊乱管理至关重要。常规脂质谱包括总胆固醇、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）和甘油三酯。还有几个额外的脂质参数作为标准谱的潜在有价值的辅助手段正在出现，包括载脂蛋白和 LDL 颗粒大小和浓度的测量，但目前大多数这些主要用作研究工具。一个主要的例外是非高密度脂蛋白胆固醇（non-HDL-C），它可用于常规临床应用。本综述概述了许多研究，这些研究清楚地证实了非高密度脂蛋白胆固醇（non-HDL-C）作为致动脉粥样硬化脂蛋白综合指标的临床实用性，甚至优越性。几年前，在美国国家胆固醇教育计划成人治疗专家组 III 国家脂质治疗指南中，非高密度脂蛋白胆固醇（non-HDL-C）被强调为治疗的关键次要目标，最近在糖尿病协会和美国心脏病学会制定的脂蛋白管理共识指南中，它被进一步强调为治疗的主要目标。非高密度脂蛋白胆固醇（non-HDL-C）在预测心血管事件方面优于 LDL-C，并且与 LDL-C 和其他传统脂质参数相比具有许多其他优势。重要的是，它可以直接从常规脂质谱中的值计算得出，无需额外费用。我们认为，所有常规脂质谱都应报告非高密度脂蛋白胆固醇（non-HDL-C），并在血脂异常管理中定期使用，以实现最佳的动脉粥样硬化和心血管疾病预防。
