When I joined Pritikin in 1998, they started moving to using non-HDL as a marker. Over the years, the evidence has continued to grow. Here are some of their articles on it
What is non-HDL cholesterol?
Find Out Why Knowing Your non-Hdl Cholesterol May Be Even More Important Than Knowing Your Ldl (Bad) Cholesterol.
https://www.pritikin.com/your-health/he ... erolq.html
Non-HDL Cholesterol Goal | What’s Optimal?
For Years Most Scientists Agreed That Lowering LDL (Known As The “Bad” Cholesterol) Was The Most Important Goal For Reducing Heart Attack Risk. But there is now growing consensus that a better predictor of cardiovascular disease risk is non-HDL cholesterol. What is non-HDL cholesterol? What is an optimal non-HDL cholesterol goal? Find out in this article.
https://www.pritikin.com/good-non-hdl-cholesterol-goal
If you have ever had a private consult with me involving your lipid numbers, you know I would recommend looking at non-HDL and not just LDL.
In 2011, I had the following discussion on a list with some of the WFPB doctors on how and why non-HDL cholesterol could be a better choice then LDL or just LDL as you will see..
"An article in this week's New England Journal of Medicine (NEJM) is shedding some light on why the HDL cholesterol number may not always be as predictive as many clinicians have thought of. For more than 35 years, much emphasis has been placed by cardiologists and lipid specialists on the importance of high HDL numbers as a vaso- and cardio-protective substance.
In contrast, in our program we have emphasized the importance of LDL Cholesterol as the atherogenic particle that drives atherosclerosis and with that Coronary Heart Disease, especially when these numbers are above 90 mg. We have pointed to international clinical data that shows that some populations with HDL numbers of 20 to 25 are totally free of heart disease, which according to the HDL believers should have placed them at a high coronary risk, since the HDL numbers often used as being considered cardio-protective should be over 40 mg for men and over 50 mg for women. We have pointed out that the body does not need high protective HDL numbers if the dangerous LDL numbers are low (less than 90 mg%). This week's article in the NEJM goes one step further, in that it may not be the number in HDL that is influencing coronary risk but what its functional capacity is. Please take a look at a summary article by a science reporter at http://consumer.healthday.com/Article.asp?AID=648737
And for some of you: please stop worrying when the HDL numbers as a result of a healthier diet go down. Please note: when that happens as it usually does, you will also notice that the LDL numbers have dropped even further (percentage wise).
Lesson: When you don't have a lot of dangerous LDL hanging around, you don't need a lot of HDL to haul it off. And besides, the new wrinkle is: with a healthier diet, the HDL may become much more effective in its functional capacities."
None of this should be new to any of you. Low HDL in the presence of very low Total Cholesterol and LDL as a result of a healthy lifestyle and diet, is usually not an issue. And high HDL, in and of itself, may not be protective.
However, here was my response to the above, putting non-HDL into perspective...
One of the ways I have found to minimize the (misguided) focus on HDL that others have is to use. non-HDL cholesterol, which is actually a well established and known risk factor.
Here is an excerpt from an actual patient from this week...
+++++++++++++++++++++++++++++++++
Labs from 3/1/10
3/1/10
Total - 205
LDL - 126
HDL - 36
VLDL - 43
Trig - 214
Than labs from 10/29/10
Total - 99
LDL - 57
HDL - 25
VLDL - 17
Trig - 86
The patient was so concerned because his HDL dropped from 36, which was low, to 25, which was now alarming to them. And, of course, in spite of all the other highly significant drops in TC, LDL, VLDL, TG, his doctor was very concerned.
Here was my response to the patient...
Non-HDL cholesterol is based on the premise that if HDL is "good", and all else is "bad," not only your LDL cholesterol but also your levels of VLDL, IDL, and chylomicroms, then lets measure the total "bad". The standard recommendations are to keep non-HDL cholesterol to below 140, with 120 being better and 100 being optimal. All we have to do is subtract HDL from the Total cholesterol and we get total non-HDL cholesterol.
When we figure out his non-HDL cholesterol.
Before
205-36 = 169 which is high risk
After
99-25 = 74 which is no risk and optimal.
+++++++++++++++++++++++++++++++++++++++
As we can see in the above example, even with a lower HDL, the non-HDL puts it in better perspective.
I included 2 articles on non-HDL cholesterol for you too
Thanks
Jeff
These are the 2 articles I included.... (a pubmed search will review several overs)
NON-HDL CHOLESTEROL: MEASUREMENT, INTERPRETATION, AND SIGNIFICANCE*
Adv Stud Med. 2007;7(1):8-11)
Vol. 7, No. 1 February 2007
http://jhasim.com/files/articlefiles/pdf/8-11.pdf
ABSTRACT
The reduction of cardiovascular risk by low- ering low-density lipoprotein cholesterol (LDL-C) levels is well documented, and LDL-C remains the main target of lipid-lowering therapy. However, not all patients with coronary heart disease have elevated LDL-C levels. There is growing recogni- tion that non–high-density lipoprotein cholesterol (HDL-C) also strongly relates to cardiovascular risk. Non–HDL-C can be calculated by subtract- ing HDL-C from total cholesterol, and encom- passes all cholesterol present in potentially atherogenic lipoprotein particles (very low den- sity-lipoproteins, remnants, intermediate-density lipoproteins, LDL, and lipoprotein[a]). Non–HDL- C may be a particularly important measure in certain populations, such as patients with dia- betes, in whom dyslipidemia is characterized by low HDL-C levels and elevated triglycerides. Non–HDL-C has been shown to correlate with coronary artery disease severity and progression as well as predict cardiovascular morbidity and mortality.
Clinical Relevance of Non-HDL Cholesterol in Patients With Diabetes
Anne L. Peters, MD
Clinical Diabetes 2008 Jan; 26(1): 3-7. https://doi.org/10.2337/diaclin.26.1.3
Abstract
IN BRIEF
Patients with type 2 diabetes have high rates of cardiovascular disease (CVD), much of which may be preventable with appropriate treatment of lipid abnormalities. Diabetic dyslipidemia most commonly manifests as elevated triglycerides and low levels of HDL cholesterol, with a predominance of small, dense LDL particles amid relatively normal LDL cholesterol levels. In diabetic patients, non-HDL cholesterol may be a stronger predictor of CVD than LDL cholesterol or triglycerides because it correlates highly with atherogenic lipoproteins. Target goals for LDL and non-HDL cholesterol in patients with diabetes are < 100 and < 130 mg/dl, respectively. Failure to consider the importance of non-HDL cholesterol in type 2 diabetes may result in undertreatment of patients with diabetes.
Recently, there were two more articles on the topic that I think really confirm the value of non-HDL in a standard lipid profile....
The first, on non-HDL and its value over LDL
Why Do Doctors Still Rely on LDL Instead of non-HDL Cholesterol?
October 15, 2017
Larry Husten
http://www.cardiobrief.org/2017/10/15/w ... olesterol/
"–There’s broad agreement that non-HDL is a better measure than LDL.
For decades lipid experts have been saying that non-HDL is preferable to LDL cholesterol in the assessment of cardiovascular risk.
The subject is not controversial. Although they may disagree about its precise significance, every expert I contacted agreed that non-HDL is superior to LDL. Further, there is no downside to non-HDL, since obtaining a non-HDL level requires no additional cost or testing."
And the second on why non-HDL may be better then even the new LDL calculation.
CardioBrief: New And Improved LDL Numbers
Lab companies start reporting more accurate LDL cholesterol measurements
by Larry Husten, CardioBrief
October 27, 2017
https://www.medpagetoday.com/Cardiology ... rief/68836
The improved LDL number produces a risk estimate that is more concordant with non-HDL cholesterol, which many lipid experts say is the preferred number to use in risk calculations. .
I don't see this as breaking news, or saying that anything needs to change about the dietary guidelines and principles recommended.
What it does do for those following this way of life, is put the basic lipid profile into better perspective, especially in regard to the value of HDL, especially in regard to a low HDL,
In Health
Jeff