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. 2011 Mar;57(3):490-501.
doi: 10.1373/clinchem.2010.154773. Epub 2011 Jan 12.

Non-HDL cholesterol shows improved accuracy for cardiovascular risk score classification compared to direct or calculated LDL cholesterol in a dyslipidemic population

Hendrick E van Deventer  1 , W Greg Miller, Gary L Myers, Ikunosuke Sakurabayashi, Lorin M Bachmann, Samuel P Caudill, Andrzej Dziekonski, Selvin Edwards, Mary M Kimberly, William J Korzun, Elizabeth T Leary, Katsuyuki Nakajima, Masakazu Nakamura, Robert D Shamburek, George W Vetrovec, G Russell Warnick, Alan T Remaley
Affiliations

Non-HDL cholesterol shows improved accuracy for cardiovascular risk score classification compared to direct or calculated LDL cholesterol in a dyslipidemic population

Hendrick E van Deventer et al. Clin Chem. 2011 Mar.

Abstract

Background: Our objective was to evaluate the accuracy of cardiovascular disease (CVD) risk score classification by direct LDL cholesterol (dLDL-C), calculated LDL cholesterol (cLDL-C), and non-HDL cholesterol (non-HDL-C) compared to classification by reference measurement procedures (RMPs) performed at the CDC.

Methods: We examined 175 individuals, including 138 with CVD or conditions that may affect LDL-C measurement. dLDL-C measurements were performed using Denka, Kyowa, Sekisui, Serotec, Sysmex, UMA, and Wako reagents. cLDL-C was calculated by the Friedewald equation, using each manufacturer's direct HDL-C assay measurements, and total cholesterol and triglyceride measurements by Roche and Siemens (Advia) assays, respectively.

Results: For participants with triglycerides<2.26 mmol/L (<200 mg/dL), the overall misclassification rate for the CVD risk score ranged from 5% to 17% for cLDL-C methods and 8% to 26% for dLDL-C methods when compared to the RMP. Only Wako dLDL-C had fewer misclassifications than its corresponding cLDL-C method (8% vs 17%; P<0.05). Non-HDL-C assays misclassified fewer patients than dLDL-C for 4 of 8 methods (P<0.05). For participants with triglycerides≥2.26 mmol/L (≥200 mg/dL) and<4.52 mmol/L (<400 mg/dL), dLDL-C methods, in general, performed better than cLDL-C methods, and non-HDL-C methods showed better correspondence to the RMP for CVD risk score than either dLDL-C or cLDL-C methods.

Conclusions: Except for hypertriglyceridemic individuals, 7 of 8 dLDL-C methods failed to show improved CVD risk score classification over the corresponding cLDL-C methods. Non-HDL-C showed overall the best concordance with the RMP for CVD risk score classification of both normal and hypertriglyceridemic individuals.

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Conflict of interest statement

Authors’ Disclosures or Potential Conflicts of Interest: Upon manuscript submission, all authors completed the Disclosures of Potential Conflict of Interest form. Potential conflicts of interest:

  1. Employment or Leadership: W.G. Miller, Clinical Chemistry, AACC; G.L. Myers, AACC.

  2. Consultant or Advisory Role: None declared.

  3. Stock Ownership: None declared.

  4. Honoraria: None declared.

  5. Research Funding: G. Miller, principal investigator for the project: Denka Seiken, Kyowa Medex, Sekisui Medical, Serotec, Sysmex International Reagents, UMA, and Wako Pure Chemical Industries donated reagents, calibrators, and controls and contributed financial support to Pacific Biometrics Research Foundation. Genzyme and Pointe Scientific contributed financial support to Pacific Biometrics Research Foundation. Pacific Biometrics Research Foundation provided a grant to Virginia Commonwealth University (funded by the financial contributions noted above). Roche Diagnostics donated reagents, calibrators, controls, and a Hitachi 917 instrument. H.E. van Deventer, Warren Grant Magnuson Clinical Center, Intramural Research Program of the National Institutes of Health. A.T. Remaley, Warren Grant Magnuson Clinical Center, Intramural Research Program of the National Institutes of Health.

Expert Testimony: None declared.

Figures

Fig. 1
Fig. 1. Misclassification rate for CVD risk for those participants with TG levels <2.26 mmol/L (200 mg/dL), n = 145
Percent of test results that were classified into either a higher (shaded bar) or lower (hatched bar) CVD risk category compared to RMPs are shown for dLDL-C (A), cLDL-C (B), or non–HDL-C (C). De, Denka; Ky, Kyowa; Ro, Roche; Sr, Serotec; Sk, Sekisui, Sy, Sysmex; Um, UMA; Wa, Wako.
See this image and copyright information in PMC

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