Discordance between high non-HDL cholesterol and high LDL-cholesterol among US adults

J Clin Lipidol. 2014 Jan-Feb;8(1):86-93. doi: 10.1016/j.jacl.2013.11.001. Epub 2013 Nov 8.


Background: Although low-density lipoprotein cholesterol (LDL-C) is recommended as the primary marker to guide lipid-lowering therapy, some data suggest non-high-density lipoprotein cholesterol (non-HDL-C) may better reflect coronary heart disease risk. Discordance between these measures has not been evaluated.

Methods: We used data from the National Health and Nutrition Examination Surveys 2005-2010 (n = 4986) to examine the discordance between these lipid parameters. Elevated levels of non-HDL-C and LDL-C were defined by using the 2004 Adult Treatment Panel III guidelines.

Results: The prevalence of high non-HDL-C and LDL-C was 22.7% and 24.5%, respectively. Of participants with high non-HDL-C, 9.7% had normal LDL-C, whereas 15.7% of participants with high LDL-C had normal non-HDL-C. We estimate 3.9 million US adults had high non-HDL-C and normal LDL-C, whereas 6.8 million US adults had high LDL-C and normal non-HDL-C. Persons with high non-HDL-C and normal LDL-C were older, more likely to be men, Hispanic, and have impaired fasting glucose, diabetes metabolic syndrome, and more risk factors for coronary heart disease.

Conclusions: Substantial discordance exists between high non-HDL-C and high LDL-C among US adults. Reliance on either single measure could result in failure to classify cardiovascular heart disease risks appropriately.

Keywords: Cholesterol screening; Coronary heart disease; Dyslipidemia; Epidemiology; Practice guidelines.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cholesterol, HDL / blood*
  • Cholesterol, LDL / blood*
  • Female
  • Humans
  • Male
  • Nutrition Surveys
  • Prevalence
  • Triglycerides / blood
  • United States / epidemiology


  • Cholesterol, HDL
  • Cholesterol, LDL
  • Triglycerides