European journal of internal medicine · 2026
non-HDL-C: The missing parameter in primary care.
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Baeza-Delgado Carlos, Sauri Inma, Diaz Javier, Fernandez Antonio, Forner Maria Jose, Martinez Fernando, Martinez Sergio, Redon Josep
Аннотация
OBJECTIVE: To assess the prevalence of elevated non-HDL-C values in the general population in the absence of lipid-lowering drugs. Association with metabolic diseases and the risk to develop new ones were analyzed using data from electronic health records.
PATIENTS AND METHODS: 820,318 subjects with at least two lipid measurements between 2012 and 2016, and without lipid-lowering drug treatment, were included. Once selected, non-HDL-C and LDL-C + 30 were calculated, with non-HDL-C being defined as elevated if it was higher than LDL-C + 30 mg (4.00 mmol) on two consecutive occasions. The prevalence of metabolic diseases in subjects with or without elevated non-HDL-C was assessed. Subjects with elevated non-HDL-C and an equal number of controls, selected using propensity score matching, were observed for five years, during which time new diagnoses of diseases with a metabolic component were evaluated.
RESULTS: 101,939 subjects have elevated non-HDL-C more prevalent in patients with type 2 diabetes, hypertension, obesity, steatohepatitis (NASH), chronic kidney disease (CKD) and cardiovascular disease. During follow-up, new diagnoses of diabetes (hazard ratio (HR) 2.529, 95% confidence interval (CI) 2.392-2.672), hypertension (HR 1.365, 95% CI 1.286-1.450) and MASLD (HR 1.365, 95% CI 1.286-1.450) were associated with elevated non-HDL-C levels, as assessed using Cox models that included age, sex, triglycerides, LDL-C and non-HDL-C as covariates.
CONCLUSION: Non-HDL-C assessment and monitoring should be included in routine healthcare and evaluated during lipid testing, since it is a risk marker that requires monitoring to improve control of metabolic diseases.
PATIENTS AND METHODS: 820,318 subjects with at least two lipid measurements between 2012 and 2016, and without lipid-lowering drug treatment, were included. Once selected, non-HDL-C and LDL-C + 30 were calculated, with non-HDL-C being defined as elevated if it was higher than LDL-C + 30 mg (4.00 mmol) on two consecutive occasions. The prevalence of metabolic diseases in subjects with or without elevated non-HDL-C was assessed. Subjects with elevated non-HDL-C and an equal number of controls, selected using propensity score matching, were observed for five years, during which time new diagnoses of diseases with a metabolic component were evaluated.
RESULTS: 101,939 subjects have elevated non-HDL-C more prevalent in patients with type 2 diabetes, hypertension, obesity, steatohepatitis (NASH), chronic kidney disease (CKD) and cardiovascular disease. During follow-up, new diagnoses of diabetes (hazard ratio (HR) 2.529, 95% confidence interval (CI) 2.392-2.672), hypertension (HR 1.365, 95% CI 1.286-1.450) and MASLD (HR 1.365, 95% CI 1.286-1.450) were associated with elevated non-HDL-C levels, as assessed using Cox models that included age, sex, triglycerides, LDL-C and non-HDL-C as covariates.
CONCLUSION: Non-HDL-C assessment and monitoring should be included in routine healthcare and evaluated during lipid testing, since it is a risk marker that requires monitoring to improve control of metabolic diseases.