Lab Med Online.  2011 Jul;1(3):121-131.

Translation: Non-HDL Cholesterol Shows Improved Accuracy for Cardiovascular Risk Score Classification Compared to Direct or Calculated LDL Cholesterol in a Dyslipidemic Population

• van Deventer HE
• Miller WG
• Myers GL
• Sakurabayashi I
• Bachmann L
• Caudill SP
• Dziekonski A
• Edwards S
• Kimberly M
• Korzun WJ
• Leary ET
• Nakajima K
• Nakamura M
• Shamburek
• Vetrovec G
• Warnick GR
• Remaley AT

Abstract

BACKGROUND
Our objective was to evaluate the accuracy of cardiovascular disease (CVD) risk score classification by direct LDL cholesterol (dLDL-C), calculated LDL cholesterol (cLDL-C), and non-HDL cholesterol (non-HDL-C) compared to classification by reference measurement procedures (RMPs) performed at the CDC.
METHODS
Weexamined 175 individuals, including 138 with CVD or conditions that may affect LDL-C measurement. dLDL-C measurements were performed using Denka, Kyowa, Sekisui, Serotec, Sysmex, UMA, and Wako reagents. cLDL-C was calculated by the Friedewald equation, using each manufacturer's direct HDL-C assay measurements, and total cholesterol and triglyceride measurements by Roche and Siemens (Advia) assays, respectively.
RESULTS
For participants with triglycerides <2.26 mmol/L (<200 mg/dL), the overall misclassification rate for the CVD risk score ranged from 5% to 17% for cLDL-C methods and 8% to 26% for dLDL-C methods when compared to the RMP. Only Wako dLDL-C had fewer misclassifications than its corresponding cLDL-C method (8% vs 17%; P<0.05). Non-HDL-C assays misclassified fewer patients than dLDL-C for 4 of 8 methods (P<0.05). For participants with triglycerides > or =2.26 mmol/L (> or =200 mg/dL) and <4.52 mmol/L (<400 mg/dL), dLDL-C methods, in general, performed better than cLDL-C methods, and non-HDL-C methods showed better correspondence to the RMP for CVD risk score than either dLDL-C or cLDL-C methods.
CONCLUSIONS
Except for hypertriglyceridemic individuals, 7 of 8 dLDL-C methods failed to show improved CVD risk score classification over the corresponding cLDL-C methods. Non-HDL-C showed overall the best concordance with the RMP for CVD risk score classification of both normal and hypertriglyceridemic individuals.

MeSH Terms

Cardiovascular Diseases
Cholesterol
Cholesterol, LDL
Humans
Indicators and Reagents
Triglycerides
Cholesterol
Cholesterol, LDL
Indicators and Reagents
Triglycerides

Figure

• 

  Fig. 1 Misclassification rate for CVD risk for those participants with TG levels <2.26 mmol/L (200 mg/dL), N=145. Percent of test results that were classified into either a higher (shaded bar) or lower (hatched bar) CVD risk category compared to RMPs are shown for dLDL-C (A), cLDL-C (B), or non-HDL-C (C). De, Denka; Ky, Kyowa; Ro, Roche; Sr, Serotec; Sk, Sekisui, Sy, Sysmex; Um, UMA; Wa, Wako.

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