Luo Yonghong, Peng Daoquan
Department of Cardiovascular Medicine, The Second Xiangya Hospital of Central South University, Changsha, China.
J Cardiovasc Pharmacol Ther. 2023 Jan-Dec;28:10742484231189597. doi: 10.1177/10742484231189597.
Cardiovascular disease (CVD) caused by atherosclerosis is the leading cause of death worldwide. The level of low-density lipoprotein cholesterol (LDL-C), considered as the initiator of atherosclerosis, is the most widely used predictor for CVD risk and LDL-C has been the primary target for lipid-lowering therapies. However, residual CVD risk remains high even with very low levels of LDL-C. This residual CVD risk may be due to remnant cholesterol, high triglyceride levels, and low high-density lipoprotein cholesterol (HDL-C). Non-high density lipoprotein cholesterol (non-HDL-C), which is calculated as total cholesterol minus HDL-C (and represents the cholesterol content of all atherogenic apolipoprotein B-containing lipoproteins), has emerged as a better risk predictor for CVD than LDL-C and an alternative target for CVD risk reduction. Major international guidelines recommend evaluating non-HDL-C as part of atherosclerotic CVD risk assessment, especially in people with high triglycerides, diabetes, obesity, or very low LDL-C. A non-HDL-C target of <130 mg/dL (3.4 mmol/L) has been recommended for patients at very high risk, which is 30 mg/dL (0.8 mmol/L) higher than the corresponding LDL-C target goal. Non-HDL-C lowering approaches include reducing LDL-C and triglyceride levels, increasing HDL-C, or targeting multiple risk factors simultaneously. However, despite the growing evidence for the role of non-HDL-C in residual CVD risk, and recommendations for its assessment in major guidelines, non-HDL-C testing is not routinely done in clinical practice. Thus, there is a need for increased awareness of the need for non-HDL-C testing for ascertaining CVD risk and concomitant prevention of CVD.
动脉粥样硬化引起的心血管疾病（CVD）是全球主要的死亡原因。低密度脂蛋白胆固醇（LDL-C）水平被认为是动脉粥样硬化的起始因素，是评估CVD风险最广泛使用的指标，并且LDL-C一直是降脂治疗的主要靶点。然而，即使LDL-C水平极低，残余CVD风险仍然很高。这种残余CVD风险可能归因于残余胆固醇、高甘油三酯水平和低高密度脂蛋白胆固醇（HDL-C）。非高密度脂蛋白胆固醇（non-HDL-C）通过总胆固醇减去HDL-C计算得出（代表所有含载脂蛋白B的致动脉粥样硬化脂蛋白的胆固醇含量），已成为比LDL-C更好的CVD风险预测指标，也是降低CVD风险的替代靶点。主要国际指南建议将评估non-HDL-C作为动脉粥样硬化性CVD风险评估的一部分，特别是在甘油三酯高、糖尿病、肥胖或LDL-C极低的人群中。对于极高风险患者，建议non-HDL-C目标<130 mg/dL（3.4 mmol/L），比相应的LDL-C目标高30 mg/dL（0.8 mmol/L）。降低non-HDL-C的方法包括降低LDL-C和甘油三酯水平、提高HDL-C或同时针对多个风险因素。然而，尽管越来越多的证据表明non-HDL-C在残余CVD风险中的作用，并且主要指南也建议对其进行评估，但临床实践中并未常规进行non-HDL-C检测。因此，有必要提高对通过检测non-HDL-C来确定CVD风险并同时预防CVD的必要性的认识。
