Non-HDL Cholesterol: When—and How—to Treat

Reducing low-density lipoprotein cholesterol (LDL-C) levels does not eliminate cardiovascular risk; most patients obtain only a 25% to 35% risk reduction. When the triglyceride level is above 200 mg/dL, non–high-density lipoprotein cholesterol (non–HDL-C) is a more precise therapeutic target than LDL-C. It can serve as an excellent proxy for assessing the total number of circulating atherogenic particles. Non–HDL-C may be superior to LDL-C in predicting cardiovascular disease and should be used as the primary lipid target in persons with diabetes, who characteristically have a dyslipidemia that consists of decreased HDL-C levels, elevated triglyceride levels, and normal to elevated LDL-C levels.