New therapeutic goals in the treatment of dyslipidemia: non-HDL cholesterol and remnant cholesterol

Abstract

Non-HDL-C is a powerful indicator of lipoproteins rich in ApoB. Its measurement is much simpler, it does not require fasting to quantify it, not being influenced by triglyceride levels, and it is an excellent marker of atherogenic cholesterol, with a better correlation with cardiovascular risk than LDL-C. In patients in high risk of atherogenic dyslipidemia, the strategy of considering
non-HDL-C as a primary objective is allowed, because it incorporates the risk of lipid origin better than LDL-C and because it is more feasible than measuring ApoB. The therapeutic objective of non-HDL-C is to add 30 mg/dL to the calculated LDL-C target value; in the general population, optimal non-HDL-C levels of less than 130 mg/dL are maintained. In a patient considered in very high risk, the target LDL-C is less than 55 mg/dL; thus their non-HDL-C should not exceed 85 mg/dL. Non-HDL cholesterol becomes an excellent indicator of total atherogenic cholesterol. And it is a primary therapeutic objective in individuals with atherogenic dyslipidemia. Evidence available to date shows the benefit of adding ethyl eicosapentaenoic acid to patients with elevated
non-HDL cholesterol under optimal treatment with statins, for reducing cardiovascular risk. Fibrates may be considered in patients with extreme hypertriglyceridemia.