Novel unbiased equations to calculate triglyceride-rich lipoprotein cholesterol from routine non-fasting lipids

BACKGROUND: Non-fasting triglyceride-rich lipoproteins cholesterol (TRL-C) contributes to cardiovascular risk, in that it includes remnant cholesterol (RC). TRL-C is computed as total C - LDL-C + HDL-C. Such calculation applies only if LDL-C is directly measured, or obtained from a non-Friedewald's formula, a method as yet never benchmarked against independent markers of TRL burden. METHODS: The Discriminant Ratio (DR) methodology was used in 120 type 2 diabetic patients in order: (i) to compute TRL-C from non-fasting lipids; (ii) to establish the performance of TRL-C and TRL-C/apoA-I (vs. TG-based markers) to grade TRLs and atherogenic dyslipidemia (AD); and (iii) to relate TRL-C with non-fasting TG. RESULTS: Depending on apoB100 availability, TRL-C (mg/dL) can be derived from non-fasting lipids in two ways: (a) total cholesterol (TC) - (0.0106 * TC - 0.0036 * TG + 0.017 * apoB100 - 0.27) * 38.6 - HDL-C; and (b) TC - (0.0106 * TC - 0.0036 * TG + 0.017 * [0.65 * (TC - HDL-C) + 6.3 - 0.27) * 38.6] - HDL-C. Discrimination between logTG and TRL-C was similar (DR 0.94 and 0.84, respectively), whereas that of logTG/HDL-C was better than TRL-C/apoA-I (DR 1.01 vs. 0.65; p 0.0482). All Pearson's correlations between pairs reached unity, allowing formulation of two unbiased equivalence equations: (a) TRL-C = 97.8 * logTG - 181.9; and (b) TRL-C/apoA-I = 8.15 * (logTG/HDL-C) - 0.18. CONCLUSIONS: TRL-C and logTG are as effective and interchangeable for assessing remnant atherogenic particles. For grading TRL-AD, it is best to use logTG/HDL-C, inherently superior to TRL-C/apoA-I, while measuring the same underlying variable.