Non-HDL Cholesterol Is Less Informative Than the Total-to-HDL Cholesterol Ratio in Predicting Cardiovascular Risk in Type 2 Diabetes

It has been suggested by some authors that non-HDL cholesterol, defined as total cholesterol minus HDL cholesterol, may be a particularly useful predictor of cardiovascular risk (1) and easier to calculate than the commonly used total-to-HDL cholesterol ratio. We have examined whether the U.K. Prospective Diabetes Study (UKPDS) Risk Engine (2), a coronary heart disease (CHD) risk calculator developed specifically for type 2 diabetes that uses the total-to-HDL cholesterol ratio, could be improved by substituting non-HDL cholesterol. The UKPDS Risk Engine encapsulates a parametric model to estimate the risk of CHD, defined as myocardial infarction or sudden cardiac death, derived from the UKPDS, with 53,000 patient-years of follow-up data (3). For this analysis, 4,540 of the 5,102 UKPDS patients were included, for whom sufficient data were available and whose characteristics have been previously reported (2). Briefly, the UKPDS recruited patients with newly diagnosed type 2 diabetes but no recent myocardial infarction or stroke. They were mean age 53 years (range 25–65), 58% male, 83% white-Caucasian, 10% Indian-Asian, 8% Afro-Caribbean, and 30% were smokers at study entry. Mean (±SD) HbA1c, 1–2 years after study entry, was 6.7 ± 1.4%, systolic blood pressure was 136 ± 20 mmHg, total cholesterol was 5.4 ± 1.0 mmol/l, and HDL cholesterol was …