Key result
Higher serum triglyceride levels progressively decrease the lipoprotein composition factor for triglyceride-rich lipoproteins, causing non-HDL cholesterol to include more cholesterol from larger TRLs.
Why the study?
Calculated non-HDLC should selectively include cholesterol from atherogenic lipoproteins, but whether serum triglyceride levels impact its ability to do so in hypertriglyceridemia is unclear.
Does serum triglyceride level impact the ability of calculated non-HDL cholesterol to accurately represent cholesterol from atherogenic lipoproteins?
Observational (n=163,803)
Does serum triglyceride level impact the ability of calculated non-HDL cholesterol to accurately represent cholesterol from atherogenic lipoproteins?
Calculated non-HDL cholesterol is influenced by triglyceride levels, progressively including more cholesterol from less atherogenic larger triglyceride-rich lipoproteins as triglycerides increase.
High TG may bias calculated non-HDL-C toward less atherogenic particles; leaves open whether direct assays improve risk prediction.
CONTEXT: Calculated non-high-density lipoprotein (HDL) cholesterol (non-HDLC) should selectively include cholesterol from atherogenic lipoproteins to be a reliable risk marker of cardiovascular disease. In hypertriglyceridemia (HTG), there is increased abundance of larger and less atherogenic triglyceride-rich lipoproteins (TRL), namely, larger very-low-density lipoproteins (VLDL), and chylomicrons. OBJECTIVE: We aim to demonstrate that serum triglyceride (TG) level has a substantial impact on non-HDLC's ability to represent cholesterol from atherogenic lipoproteins, even though TG is not part of the calculation for non-HDLC. DESIGN: Analysis of lipid profile data. SETTINGS: Lipid Clinic patient cohort, and Biochemistry Laboratory patient cohort. PATIENTS OR OTHER PARTICIPANTS: 7,492 patients in the Lipid Clinic cohort with baseline lipid profiles documented prior to starting lipid-lowering medications and 156,311 lipid profiles from The Ottawa Hospital Biochemistry Laboratory cohort. INTERVENTION: None. MAIN OUTCOME MEASURE: Our modeling process includes derivation of TG-interval-specific lipoprotein composition factor (LCF) for TRL, which represents the mass ratio of cholesterol to TG in TRL. A high LCF indicates that the TRLs are mainly the cholesterol-rich atherogenic remnant lipoproteins. A low LCF indicates that the TRLs are mainly the TG-rich larger VLDL and chylomicrons. RESULTS: As serum TG increases, there is progressive decline in the LCF for TRL, which indicates that the calculated non-HDLC level reflects progressive inclusion of cholesterol from larger TRL. This is shown in both cohorts. CONCLUSIONS: Calculated non-HDLC is influenced by TG level. As TG increases, non-HDLC gradually includes more cholesterol from larger TRL, which are less atherogenic than LDL and remnant lipoproteins.
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Sun et al. (2019) conducted an observational in Hypertriglyceridemia (n=163,803). Serum triglyceride level was evaluated on Lipoprotein composition factor (LCF) for triglyceride-rich lipoproteins (TRL). Higher serum triglyceride levels progressively decrease the lipoprotein composition factor for triglyceride-rich lipoproteins, causing non-HDL cholesterol to include more cholesterol from larger TRLs.
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