Non-HDL Cholesterol and Triglycerides

Abstract

Objectives-Non-high-density lipoprotein cholesterol (non-HDLC) levels reflect the full burden of cholesterol transported in atherogenic lipoproteins. Genetic studies suggest a causal association between elevated triglycerides (TGs)-rich lipoproteins and atherosclerosis. We evaluated associations between achieved non-HDLC and TG levels on changes in coronary atheroma volume. Approach and Results-Data were analyzed from 9 clinical trials involving 4957 patients with coronary disease undergoing serial intravascular ultrasonography to assess changes in percent atheroma volume (∆PAV) and were evaluated against on-treatment non-HDLC and TG levels. The effects of lower (<100 mg/dL) versus higher (≥100 mg/dL) achieved non-HDLC levels and lower (<200 mg/dL) versus higher (≥200 mg/dL) achieved TG levels were evaluated in populations with variable on-treatment low-density lipoprotein cholesterol (LDLC) </≥70 mg/dL and C-reactive protein </≥2 mg/L and in patients with or without diabetes mellitus. On-treatment non-HDLC levels linearly associated with ∆PAV. Overt PAV progression (∆PAV>0) was associated with achieved TG levels >200 mg/dL, respectively. Lower on-treatment non-HDLC and TG levels associated with significant PAV regression compared with higher non-HDLC and TG levels across all levels of LDLC and C-reactive protein and irrespective of diabetic status (P<0.001 across all comparisons). ∆PAV were more strongly influenced by changes in non-HDLC (β=0.62; P<0.001) compared with changes in LDLC (β=0.51; P<0.001). Kaplan-Meier sensitivity analyses demonstrated significantly greater major adverse cardiovascular event rates in those with higher versus lower non-HDLC and TG levels, with an earlier separation of the non-HDLC compared with the LDLC curve. Conclusions-Achieved non-HDLC levels seem more closely associated with coronary atheroma progression than LDLC.Plaque progression associates with achieved TGs, but only above levels of 200 mg/dL. These observations support a more prominent role for non-HDLC (and possibly TG) lowering in combating residual cardiovascular risk. 14 Accordingly, the relationship between achieved non-HDLC and TG levels upon coronary atheroma progression rates has yet to be defined.Coronary intravascular ultrasound is a sensitive imaging tool for measuring coronary atheroma volume and continues to play an important role for evaluating the antiatherosclerotic effects of novel therapies on serial measures of coronary disease progression. 15,16 Post hoc analyses of serial intravascular ultrasound trials demonstrated significant associations between measures of disease progression and incident cardiovascular events. 17-19The present analysis aimed to define the relationship between achieved non-HDLC and TG levels with rates of coronary atheroma progression. The effects of higher versus lower non-HDLC and TG levels on plaque progression rates were specifically explored within patients stratified according to varying degrees of residual metabolic risk (defined according to achieved LDLC, C-reactive prot...

Effects of a New Nutraceutical Formulation (Berberine, Red Yeast Rice and Chitosan) on Non-HDL Cholesterol Levels in Individuals with Dyslipidemia: Results from a Randomized, Double Blind, Placebo-Controlled Study

“…Non-HDL-C reflects the full burden of the cholesterol transported in atherogenic lipoproteins and its assessment for CVD risk prediction and as a target of therapy has been emphasized in several guidelines [ 20 , 21 ]. Non-HDL-C was closely associated with plaque progression [ 22 ] and was more predictive of the severity of coronary atherosclerosis compared to LDL-C [ 23 ]; this is also true in primary prevention studies [ 6 , 7 , 8 ]. Among statin-treated patients, on-treatment levels of non-HDL-C were more strongly associated with the risk of future major CV events compared to LDL-C and ApoB in a large meta-analysis [ 24 ].…”

Endothelial Dysfunction in Obesity-Induced Inflammation: Molecular Mechanisms and Clinical Implications

“…Inflammation can be screened through the examination of inflammatory markers, popularly known as high sensitivity C-reactive protein (hs-CRP) and the inflammatory score derived from the proinflammatory cytokines, osteopontin, chemokines (C-C motif) ligand 2 (CCL2), CCL5, chemokines (C-C motif) ligand 5, cyclooxygenases (COX), connective tissues growth factors (CTGF), fractalkines (CX3CL1), iNOS, ICAM-1, NFκB and transforming growth factor β (TGFβ), TLR, and anti-inflammatory adiponectin [42][43][44]. Other related biomarkers include: growth differentiation factor-15 (GDF15), myeloid-related proteins 8/14, pentraxin 3, and lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1), which were identified as surrogate markers of atherosclerosis associated with cardiovascular diseases during obesity [45,46], while galectin-3 was described as a potential biomarker of vascular remodeling and endothelial dysfunctions attributed to inflammation in obesity [47].…”

Triglyceride-Rich Lipoproteins and Novel Targets for Anti-atherosclerotic Therapy

“…An important study published 2 years ago was the first one to show that lower plasma levels of TGs were associated with plaque regression across broad categories of CVD risk. 60) …”