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Yadong Cui, MD, PhD; Roger S. Blumenthal, MD; Jodi A. Flaws, PhD; Maura K. Whiteman, BS; Patricia Langenberg, PhD; Paul S. Bachorik, PhD; Trudy L. Bush, PhD, MHS

Arch Intern Med. 2001;161:1413-1419.

Background  Non–high-density lipoprotein cholesterol (non–HDL-C) contains all known and potential atherogenic lipid particles. Therefore, non–HDL-C level may be as good a potential predictor of risk for cardiovascular disease (CVD) as low-density lipoprotein cholesterol (LDL-C).

Objectives  To determine whether non–HDL-C level could be useful in predicting CVD mortality and to compare the predictive value of non–HDL-C and LDL-C levels.

Methods  Data are from the Lipid Research Clinics Program Follow-up Study, a mortality study with baseline data gathered from 1972 through 1976, and mortality ascertained through 1995. A total of 2406 men and 2056 women aged 40 to 64 years at entry were observed for an average of 19 years, with CVD death as the main outcome measure.

Results  A total of 234 CVD deaths in men and 113 CVD deaths in women occurred during follow-up. Levels of HDL-C and non–HDL-C at baseline were significant and strong predictors of CVD death in both sexes. In contrast, LDL-C level was a somewhat weaker predictor of CVD death in both. Differences of 0.78 mmol/L (30 mg/dL) in non–HDL-C and LDL-C levels corresponded to increases in CVD risk of 19% and 15%, respectively, in men. In women, differences of 0.78 mmol/L (30 mg/dL) in non–HDL-C and LDL-C levels corresponded to increases in CVD risk of 11% and 8%, respectively.

Conclusions  Non–HDL-C level is a somewhat better predictor of CVD mortality than LDL-C level. Screening for non–HDL-C level may be useful for CVD risk assessment.

From the Department of Epidemiology and Preventive Medicine, School of Medicine, University of Maryland (Drs Cui, Flaws, Langenberg, and Bush and Ms Whiteman), and the Division of Cardiology, Johns Hopkins Ciccarone Preventive Cardiology Center (Dr Blumenthal), and School of Medicine (Dr Bachorik), The Johns Hopkins University, Baltimore, Md.
Dr Bush died March 14, 2001.

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