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LDL is Only Half Truth; Non-HDL-C is the Real Thing

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Dr SN Narasingan, Chennai    04 January 2018

  1. Non-HDL-C is a more accurate predictor of ASCVD risk than LDL-C as it effectively measures all atherogenic lipoprotein in blood, including LDL, VLDL, IDL, Lp(a) and chylomicron remnants.
  2. Non-HDL-C is particularly informative in patients with diabetes who have high TGs and so have a greater difference between LDL-C and non-HDL-C.
  3. Non-HDL-C is an accurate predictor of residual ASCVD risk in patients already on statin therapy.
  4. No additional testing or fasting blood sample required to estimate non-HDL-C.
  5. Non-HDL-C includes both LDL-C and the TG rich non-LDL lipoproteins. It also covers, to some extent, the excess ASCVD risk imparted by the small dense form of LDL, which is significantly more atherogenic than the normal large buoyant particles.
  6. An elevated non-HDL-C, being a surrogate for elevated TG, indirectly suggests greater proportion of the small dense variety of LDL particles.

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