Non-HDL Cholesterol Versus Apolipoprotein B in Diabetic Dyslipoproteinemia

Dyslipidemia in patients with diabetes has suddenly emerged as a vital clinical issue. Whereas better glucose control has not been shown to significantly reduce vascular mortality and morbidity (1), lowering LDL cholesterol has regularly been associated with substantial benefit. This may be just the beginning; fibrate therapy also holds promise (2). The Adult Treatment Panel III (ATPIII) reaffirmed that LDL cholesterol should be the cornerstone of lipid diagnosis and therapy (3). At the same time, ATPIII also proposed that non-HDL cholesterol may be used for clinical decision making in hypertriglyceridemic patients. The argument is that non-HDL cholesterol includes the cholesterol in all the atherogenic lipoproteins and is therefore a better atherogenic index than LDL cholesterol, particularly in hypertriglyceridemic subjects. Non-HDL cholesterol has also been suggested to be an acceptable surrogate for apolipoprotein B (apoB), which measures total atherogenic particle number. Therefore non-HDL cholesterol has become an alternative for LDL cholesterol and a surrogate for apoB. The article by Wagner et al. (4), which appears in this issue of Diabetes Care , presents a serious challenge to that decision. They show convincingly that non-HDL cholesterol is not an acceptable clinical surrogate for apoB in patients with …