A study to assess the relationship between non-HDL cholesterol levels and the residual risk of atherosclerotic cardiovascular disease

Introduction. Non-HDL cholesterol (Non-HDL-C) is recognized as a superior predictor of Atherosclerotic Cardiovascular Disease (ASCVD) risk compared to LDL cholesterol. This study evaluates the association of Non-HDL-C with ASCVD risk factors, including diabetes, hypertension, lifestyle habits, and family history, using comprehensive statistical analyses. Material and methods. A hospital-based cross-sectional study was conducted at ACS Medical College, Chennai, from January to April 2025, including 80 ASCVD patients aged 20-70 years. Clinical history, vitals, lipid profile, and cardiac investigations were recorded. Statistical analysis was performed using descriptive statistics, Chi-square tests, Pearson and Spearman correlations, and multivariate regression analysis. A p-value < 0.05 was considered statistically significant. Results. The mean Non-HDL-C was 155 ± 25 mg/dL, with significantly higher levels in patients with diabetes (p = 0.00004) and hypertension (p = 0.00019). Lifestyle factors, including smoking (p = 0.0067) and alcohol consumption (p = 0.0085), were associated with elevated Non-HDL-C. Correlation analysis showed a strong positive association between Non-HDL-C and fasting blood sugar (r = 0.78, p = 0.004), triglycerides (r = 0.85, p = 0.001), and systolic blood pressure (r = 0.70, p = 0.008). Multivariate regression analysis identified triglycerides (β = 0.76, p = 0.001), postprandial blood sugar (β = 0.68, p = 0.002), and systolic blood pressure (β = 0.45, p = 0.008) as independent predictors of Non-HDL cholesterol levels. Glomerular Filtration Rate (GFR) showed a negative association (β = -0.50, p = 0.006), indicating that reduced kidney function correlates with higher Non-HDL-C levels. Conclusion. Non-HDL cholesterol is a strong independent predictor of ASCVD risk, significantly associated with diabetes, hypertension, triglycerides, and kidney function decline. The study explains the importance of early lipid screening, lifestyle modifications, and targeted interventions for ASCVD prevention and management.