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National Lipid Association Statement Regarding Reporting of Non-HDL on Standard Laboratory Reports

Adapted from an article in the Journal of Clinical Lipidology (JCL) titled, The Importance of Non-HDL Cholesterol Reporting in Lipid Management1

Laboratory result reporting plays an important role in clinical medicine, especially in lipid management, where clinical decisions are driven in large part towards attainment of goals and targets for most lipid levels. Non-High-Density Lipoprotein Cholesterol (non-HDL-C) is an inclusive measure of all known atherogenic lipoproteins and thus outperforms Low-Density Lipoprotein Cholesterol (LDL-C) in the prediction of cardiovascular disease. Unfortunately, the lack of routine non-HDL-C reporting makes it difficult for clinicians to diagnose and treat atherogenic dyslipidemias and attain non-HDL-C goals. The body of evidence in favor of reporting of non-HDL-C on major laboratory reports is substantial and the NLA requests that routine reporting of non-HDL-C be implemented as broadly and as quickly as possible.

The NLA Taskforce on Non-HDL-C recommends reporting of non-HDL-C on all standard lipid profiles, based on the following scientific evidence and potential benefits:

Benefits of Non-HDL Reporting for Clinicians

  1. Non-HDL includes all known atherogenic lipoproteins and outperforms other routine lipid measures in predicting both subclinical atherosclerosis and adverse clinical outcomes
  2. It is treatable with available lipid-lowering agents
  3. It is emphasized as an important management goal in the major national lipid treatment guidelines (including NCEP ATP III2) and in the recently released ADA/ACC3 consensus conference on Lipoprotein Management in Patients with Cardiometabolic Risk.

Benefits of Non-HDL Reporting for Laboratories and Patients

  1. It can be accurately derived from a non-fasting specimen and, thus, requires no special preparation by the patient.
  2. It is robust from a laboratory measurement standpoint, being the difference between two well-standardized assays (total cholesterol minus HDL-cholesterol)
  3. It requires no additional expense to the patient (or laboratory) since it is calculated directly from measurements performed on all routine lipid panels.

Unfortunately, the lack of routine reporting of non-HDL-C by clinical laboratories has made it difficult for clinicians to use this key measure in the diagnosis and treatment of atherogenic dyslipidemias. Since Non-HDL-C can be readily and accurately calculated on all routine lipid profiles, fasting or nonfasting without further expense to the patient, laboratory, or third-party payer, the NLA believes that the automatic reporting of Non-HDL-C will remove the artificial barrier created between the physician and the laboratory, thus, allowing for better flow of critical information that can improve cardiovascular risk identification, and improve therapeutic decision-making. The removal of this barrier should lead to an increase in the identification of patients at risk and improve provider adherence to therapy goals as outlined in the major national guidelines.

The NLA Board requests that the pathology and clinical chemistry communities as well as major clinical laboratories report non-HDL-C on all lipid panel reports. Since non-HDL-C concentrations are up to 30 mg/dL higher than LDL-C in patients with normal plasma triglyceride levels, the non-HDL-C goal is set 30 mg/dL higher than the corresponding LDL-C goal for all patient risk categories. Thus, an appropriate reference range for non-HDL-C can be derived by adding 30 mg/dL to the reference values for LDL-C.

References

1. Blaha MJ, Blumenthal R, Brinton EA, Jacobson TA. The Importance of Non-HDL Cholesterol Reporting in Lipid Management. Journ Clin Lipid. 2008;xx-xx.

2. National Cholesterol Education Program. Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Final Report. Circulation 2002;106:3143-3421.

3. Brunzell JD, Davidson M, Furberg CD, Goldberg RB, Howard BV, Stein JH, Witztum JL. Lipoprotein management in patients with cardiometabolic risk: consensus conference report from the American Diabetes Association and the American College of Cardiology Foundation. J Am Coll Cardiol. 2008;51(15):1512-24.

Author Disclosures

Michael Blaha, MD
No relevant financial relationships with any commercial interests.

Roger Blumenthal, MD
No relevant financial relationships with any commercial interests.

Eliot Brinton, MD
Consultant: Abbott, AstraZeneca, GlaxoSmithKline, Merck & Co., Daiichi-Sankyo, Sanofi-Aventis, Takeda, and Wyeth. Speaker for: Abbott, GlaxoSmithKline, Lilly, Merck & Co., Pfizer, Daiichi-Sankyo, Merck/Schering-Plough, Takeda, and Wyeth. Researcher for: Abbott, Merck & Co., Pfizer, Sanofi-Aventis, and Takeda. Honoraria received from: Abbott, AstraZeneca, GlaxoSmithKline, Lilly, Merck & Co., Pfizer, Daiichi-Sankyo, Sanofi-Aventis, Merck/Schering-Plough, Takeda, and Wyeth. Research funding from: Merck & Co., Pfizer, Sanofi-Aventis, and Takeda.

David Capuzzi, MD
Consultant: Pfizer. Speaker for: Merck/Schering-Plough, Reliant, and AstraZeneca. Honoraria received from: Merck/Schering-Plough, Reliant, AstraZeneca, and Pfizer.

John R. Crouse, MD
Consultant: Merck/Schering-Plough, AstraZeneca, Johnson & Johnson, and Reliant. Speaker for: AstraZeneca. Honoraria received from: Merck/Schering-Plough, AstraZeneca, Johnson & Johnson, and Reliant.

Michael H. Davidson, MD
Consultant: Abbott Laboratories, AstraZeneca, Kos Pharmaceuticals, Merck & Co., Merck/Schering-Plough, Pfizer Inc., Reliant Pharmaceuticals, Inc., Roche Pharmaceuticals, Sankyo Pharma, Sumitomo Pharmaceuticals and Takeda Pharmaceuticals. Speaker honoraria from Abbott Laboratories, AstraZeneca, Kos Pharmaceuticals, Merck & Co., Merck/Schering-Plough, Pfizer Inc., Reliant Pharmaceuticals, Inc., Sankyo Pharma and Takeda Pharmaceuticals. Research grants from: Abbott Laboratories, AstraZeneca, Kos Pharmaceuticals, Merck & Co., Merck/Schering-Plough, Pfizer Inc., Reliant Pharmaceuticals, Inc., Roche Pharmaceuticals, Sankyo Pharma, and Takeda Pharmaceuticals.

Anne C. Goldberg, MD
Consultant: Unilever and Abbott Laboratories. Speaker honoraria from: Merck & Co. and Merck/Schering-Plough. Research grant support from: Kos Pharmaceuticals, Pfizer Inc., Sankyo Pharma, AstraZeneca, Merck & Co., Takeda Pharmaceuticals, Abbott Laboratories, Reliant Pharmaceuticals, Sanofi-Aventis, ISIS, and Aegerion.

Terry Jacobson, MD
Consultant: Abbott, Merck & Co., Merck/Schering-Plough, Pfizer, Reliant, and AstraZeneca. Speaker for: Abbott, Merck & Co., Merck/Schering-Plough, Pfizer, Reliant, and AstraZeneca. Honoraria received from: Abbott, Merck & Co., Merck/Schering-Plough, Pfizer, Reliant, and AstraZeneca.

Peter H. Jones, MD
Consultant: Abbott Laboratories, and AstraZeneca. Speaker honoraria from: Abbott Laboratories, AstraZeneca, Merck, and Pfizer.

John Kostis, MD
Consultant: Pharmacopeia, Pfizer, Jerini, Novartis, and Merck/Schering-Plough. Speaker for: Forest. Honoraria received from: Forest. Consulting Fee received from: Pharmacopeia, Pfizer, Jerini, Novartis, and Merck/Schering-Plough.

Janet Long, MSN
Speaker for: AstraZeneca. Honoraria received from: AstraZeneca.

James McKenney, PharmD
Consultant: Abbott Laboratories, Aegerion, AstraZeneca, Merck & Co., and Daiichi Sankyo. Speaker honoraria from: AstraZeneca.

Neil J. Stone, MD
Consultant: Abbott, Merck & Co., Schering-Plough, and Unilever (honoraria donated to AHA). Speaker honoraria for educational, not promotional, activities from: Abbott, Merck & Co., Schering-Plough and Unilever. Wrote a case history for the CCMD educational website supported by a consortium of companies led by Pfizer Inc.

Maria Lopes-Virella, MD
Consultant: Merck & Co. and Merck/Schering-Plough. Honoraria received from: Merck & Co. and Merck/Schering-Plough.

Dan Wise, MD
Speaker for: Merck & Co., Merck/Schering-Plough, AstraZeneca, Pfizer, Novartis, GlaxoSmithKline, Takeda, Reliant, and Abbott. Honoraria received from: Merck & Co., Merck/Schering-Plough, AstraZeneca, Pfizer, Novartis, GlaxoSmithKline, Takeda, Reliant, and Abbott.
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Last Revision:July 29, 2011



 
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Publish Date: 
September 8, 2011 - 12:00am



by Dr. Radut.