Reducing low-density lipoprotein (LDL) cholesterol has long been the goal of medications and other cholesterol-lowering treatments. But researchers are finding that other lipoproteins appear to be involved in developing heart disease. These include some very low-density lipoproteins (VLDL) and intermediate-density lipoproteins (IDL) which are types of non-HDL cholesterol.
Studies have shown that the general category of "non-HDL" cholesterol, is a strong predictor of heart disease in people who have not yet developed signs of heart problems. As a result, the latest version of the National Cholesterol Education Program (NCEP) guidelines recommends that doctors first target LDL cholesterol, but also pay attention to non-HDL cholesterol.
"LDL cholesterol, even though it is a 'bad' cholesterol, tells only part of the story," says lead author Vera Bittner, M.D., MSPH, professor of medicine in the division of cardiovascular diseases at the University of Alabama at Birmingham. "We found that while LDL cholesterol is important, the non-HDL cholesterol is the more important predictor at least in this group of people with heart disease." The researchers studied data compiled previously during the Bypass Angioplasty Revascularization Investigation (BARI) trial, a study that followed 1,514 heart patients (73 percent male, average age 61 years) for five years, taking their cholesterol levels throughout the study period and recording their health histories. The study authors found that non-HDL cholesterol is a strong and independent predictor of non-fatal heart attack and angina (chest pain or discomfort) at five years, even after considering other risk factors, such as age and smoking.