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June 20, 2001
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Novel Measure of Blood Cholesterol Better Predicts Death From Heart Disease

The amount of non-high-density lipoprotein (non-HDL) cholesterol circulating in the blood predicts whether a person is likely to die of heart disease, according to a study led by Johns Hopkins researchers.

Non-HDL cholesterol is defined as the difference between total cholesterol and HDL or "good" cholesterol. It includes triglycerides (blood fats), low-density lipoprotein (LDL) or "bad" cholesterol, and intermediate density lipoprotein.

In a study of 4,462 adults ages 40 to 64, increasing non-HDL cholesterol level was associated with an increased risk for death related to heart disease. Men with high non-HDL cholesterol levels were twice as likely to die of heart disease as their counterparts with lower levels; in women, the risk was nearly two and a half times higher. Elevated LDL cholesterol was a weaker predictor, especially in women.

Researchers looked at the patient population in the Lipid Research Clinics Program Follow-up Study, a mortality study with baseline data gathered from 1972 to 1976. Death rates were followed through 1995. Study results were published in the June 11 issue of the Archives of Internal Medicine.

"Given the increased accuracy in predicting cardiovascular disease-related death by non-HDL cholesterol versus LDL cholesterol, blood analyses should look at total cholesterol and HDL levels when trigylcerides are elevated," says Roger S. Blumenthal, M.D., study author and director of Hopkins’ Ciccarone Center for the Prevention of Heart Disease. "This study strongly supports the recent national Adult Treatment Panel III cholesterol guidelines that in patients with elevated triglycerides (greater that 200 milligrams per deciliter), non-HDL cholesterol should be a target of therapy."

In patients with diabetes, known cardiovascular disease or high risk scores on cardiovascular disease measurement scales, the target LDL should be less than 100 mg/dL and the non-HDL cholesterol should be less than 130 mg/dL, Blumenthal says.

LDL levels can be calculated falsely low, he adds: "Doctors should strive to optimize not only their patients’ LDL levels but also their non-HDL values."

An added advantage of non-HDL measurements, Blumenthal says, is that they can be taken even when the patient has eaten. By comparison, LDL measurements can be taken only when the patient fasts, as food intake can raise triglycerides and lower LDL.

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