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treatment target among patients with coronary disease," the authors say. Specifically, they found that non-HDL was the strongest lipoprotein indicator for non-fatal heart attack and angina among total cholesterol, LDL, triglycerides (a blood fat) and HDL. There was a 4.9 percent increase in risk of heart attack for every 10 milligram per deciliter (mg/dL) increase in non-HDL cholesterol, versus a 4.3 percent increase in risk for every 10 mg/dL of total cholesterol, and a 1.6 percent increase in risk with each 10 mg/dL rise in triglycerides. The increased risk associated with increased LDL levels was not significant. They also found that non-HDL cholesterol had the most profound affect on angina, with a 4.9 percent increased risk for every 10mg/dL rise in non-HDL.

One possible reason that the LDL levels were insignificant in this study, Bittner says, is that many patients with heart disease are already on medications to lower their LDL levels.

"What we have done is purely focused on the LDL and ignored these other particles. This study tells the consumer and physician to look at the entire picture and treat both," she says.

Medications traditionally used to lower LDL, such as statins, tend to affect other lipoproteins only in part, Bittner says. Niacin and some other medications might better treat these particles that have higher triglycerides. Often patients require a combination of medications for the best results.

In an accompanying editorial, Scott M. Grundy, M.D., Ph.D., director of the departments of internal medicine and clinical nutrition at the University of Texas Southwestern Medical Center at Dallas, agrees that non-HDL cholesterol is an important part of the treatment picture. But, he says, it should be a secondary target of therapy until more evidence shows that it's more important than LDL. Currently, LDL is the main target of cholesterol treatment.

"I think the study shows that non-HDL cholesterol increasingly ap
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Contact: Carole Bullock
carole.bullock@heart.org
214-706-1279
American Heart Association
22-Oct-2002

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