Re-evaluating the Lipid Profile: Identifying Priority Parameters for Primary Care in a Developing Country

Background: Dyslipidemia is a key contributor to cardiovascular disease (CVD), particularly in low-and middle-income countries like Pakistan, where universal lipid screening is hindered by high costs and limited access. This study aimed to identify the most clinically relevant and cost-effective lipid parameters for routine screening in such settings. Materials and Methods: A retrospective analysis was conducted on 27,654 adult patients who underwent fasting lipid testing at a tertiary care hospital in Karachi between January 2021 and June 2023. Parameters included total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides (TG), and non-HDL cholesterol. Correlation analyses were stratified by age, gender, and comorbidity status (diabetes and hypertension). Results: LDL cholesterol showed strong correlations with total cholesterol ( r = 0.91) and non-HDL cholesterol ( r = 0.90), reaffirming its value as a core screening marker. HDL was the most frequently abnormal lipid parameter (76.3%) but lacked a causal association with CVD and therapeutic relevance. Elevated TG was present in 21.1% of patients, with a higher prevalence among those with diabetes and hypertension. These correlation patterns remained consistent across all demographic and clinical subgroups. Conclusion: LDL cholesterol emerged as the most clinically useful lipid marker due to its strong correlation with total and non-HDL cholesterol and its central role in cardiovascular risk. TG showed limited relevance, mainly in high-risk groups, while HDL lacked predictive value and therapeutic utility. A simplified screening approach—prioritizing LDL and selectively including TG—can reduce costs and improve access in low-resource settings like Pakistan, without compromising the clinical effectiveness.