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Curr Trend Cardiol. 2017 | Volume 1 Issue 3
September 18-19, 2017 | Toronto, Canada
Annual Conference on
HEART DISEASES
Introduction:
Non-high-density lipoprotein (non-HDL)
cholesterol is the sum of low-density lipoprotein (LDL)
cholesterol and very-low-density lipoprotein (VLDL)
cholesterol, and is usually approximated by the total
cholesterol minus HDL-cholesterol. The National Lipid
Association (NLA) has advocated the use of non-HDL
cholesterol as its favored lipid predictor. Cut-off points are
based on LDL cholesterol values, with a lower end at 100
mg/dL (2.50 mmol/L) and a higher end at 190 mg/dL (4.75
mmol/L), adding 30 mg/dL (0.75 mmol/L) to keep triglyceride
(TG) levels <150 mg/dL (1.70 mmol/L).
Objectives:
The author will demonstrate that the use of non-
HDL cholesterol has not been fully considered.
Methods:
The author will examine a general population
lipid database to demonstrate the frequency of distribution
of non-HDL cholesterol in the part of the population that
was known to have developed a form of atherothrombotic
disease (ATD) and in the part that was not known to have
done so. The effect of stratifying each non-HDL cholesterol
quintile in terms of another lipid predictor that does not
involve VLDL-cholesterol or TG will be demonstrated. The
other risk predictor is the cholesterol retention fraction
(CRF) defined as (LDL-HDL)/LDL.
Findings:
All non-HDL cholesterol quintiles above the lowest
quintile had higher frequencies in the ATD population than
in the non-ATD population. The highest two quintiles had
frequencies in the ATD population that are 2.5-times as
high as those in the non-ATD population, whereas in the
middle two quintiles, the frequency in the ATD population
was minimally higher than in the non-ATD population. In the
lowest quintile, the frequency is much higher in the non-
ATD population than in the ATD population. At any nonHDL
cholesterol quintile, the average age of ATD onset depends
on cigarette smoking (not discussed here) and the CRF. Higher
CRF levels equate to an earlier average age of ATD onset and
lower levels of CRF equate to a later onset. A 75-year-oldmale
who was a hypertensive diabetic and a former smoker was
not on statins because of low lipid levels, had clean arteries
on angiography, whereas a 45-year-old normotensive, non-
smoking patient with severe dyslipidemia (obtained at first
encounter) had a massive stroke due to carotid stenosis.
Both had non-HDL cholesterol levels in the intermediate ATD
risk quintiles.
Conclusions:
Non-HDL cholesterol is not the optimal
predictor of the population at risk of atherothrombotic
disease and its use should be reconsidered.
Speaker Biography
William E Feeman is a Physician on staff at Wood County Hospital, and in private
practice, both in Bowling Green, Ohio. He has attended Undergraduate school at Ohio
State University (1961-1966) and became interested in a career in Medicine during that
time; prior to his decision to enter Medicine, he planned to have a career in Astronomy.
He has earned his Bachelor of Science in Physiology (1961-1966). Over the last 26 plus
years, he has spent his professional life in medicine perfecting a tool to predict the
population at risk of atherothrombotic disease e and to guide therapy to maximally
stabilize/reverse that disease if extant. He has six major articles published in various
science/medical journal. He has numerous letters to the editor published in various
medical journals. All publications relate to the primary and second prevention of
atherothrombotic disease. He has presented data at many annual scientific assemblies
of the American Academy of Family Physicians and at several national and international
symposia in atherothrombotic disease. He is the founder of the Association for the
Prevention of Atherothrombotic Disease in Northwest Ohio to facilitate the spread of
knowledge about this disease.
e:
bgs43402@yahoo.comConcerns about the use of non-HDL cholesterol as a lipid predictor
William E. Feeman
Bowling Green Study, USA