Frost P H, Havel R J
Cardiovascular Research Institute and Department of Medicine, University of California, San Francisco 94143-0326, USA.
Am J Cardiol. 1998 Feb 26;81(4A):26B-31B. doi: 10.1016/s0002-9149(98)00034-4.
The plasma level of low-density lipoprotein (LDL) cholesterol is the "gold standard" for estimating the lipoprotein-related risk for complications of atherosclerotic vascular disease. LDL cholesterol concentrations are commonly estimated by the Friedewald formula that requires only the measurement (after overnight fasting) of plasma cholesterol and triglycerides along with high-density lipoprotein (HDL) cholesterol. This value, however, is not in fact a true estimate of LDL cholesterol but rather of LDL cholesterol along with variable, usually smaller, amounts of intermediate-density lipoprotein (IDL) cholesterol and lipoprotein(a). Estimation of LDL cholesterol levels by the Friedewald formula becomes progressively less accurate as plasma triglyceride concentrations increase, and the formula is generally considered inapplicable when triglyceride levels exceed 400 mg/dL. We believe that a very simple measurement-non-HDL cholesterol (serum cholesterol minus HDL cholesterol)-has considerable potential as a screening tool for identifying dyslipoproteinemias, for risk assessment, and for assessing the results of hypolipidemic therapy. Unlike the estimation of LDL cholesterol levels by the Friedewald formula, the estimation of non-HDL cholesterol concentrations requires no assumptions about the relation of very-low-density (VLDL) cholesterol levels to plasma triglyceride concentrations. This method includes all of the cholesterol present in lipoprotein particles now considered to be potentially atherogenic [VLDL, IDL, LDL, and lipoprotein(a)]. This article provides examples of the utility of non-HDL cholesterol concentrations in clinical medicine.
低密度脂蛋白（LDL）胆固醇的血浆水平是评估动脉粥样硬化性血管疾病并发症的脂蛋白相关风险的“金标准”。LDL胆固醇浓度通常通过Friedewald公式估算，该公式仅需要（过夜禁食后）测量血浆胆固醇、甘油三酯以及高密度脂蛋白（HDL）胆固醇。然而，该值实际上并非LDL胆固醇的真实估算值，而是LDL胆固醇以及可变的、通常较少的中密度脂蛋白（IDL）胆固醇和脂蛋白（a）的估算值。随着血浆甘油三酯浓度的增加，通过Friedewald公式估算LDL胆固醇水平的准确性逐渐降低，当甘油三酯水平超过400mg/dL时，该公式通常被认为不适用。我们认为，一种非常简单的测量方法——非HDL胆固醇（血清胆固醇减去HDL胆固醇）——作为一种筛查工具，在识别血脂异常、风险评估以及评估降脂治疗效果方面具有很大潜力。与通过Friedewald公式估算LDL胆固醇水平不同，估算非HDL胆固醇浓度无需对极低密度脂蛋白（VLDL）胆固醇水平与血浆甘油三酯浓度之间的关系进行假设。该方法包括现在被认为可能具有致动脉粥样硬化作用的脂蛋白颗粒中存在的所有胆固醇[VLDL、IDL、LDL和脂蛋白（a）]。本文提供了非HDL胆固醇浓度在临床医学中的应用实例。
