Non-HDL-C goals based on the distribution of population percentiles in ELSA-Brasil: Is it time to change?

Atherosclerosis. 2018 Jul:274:243-250. doi: 10.1016/j.atherosclerosis.2018.04.007. Epub 2018 Apr 12.


Background and aims: Non-high-density lipoprotein cholesterol (non-HDL-C) goals are defined as 30 mg/dL (0.78 mmol/L) higher than the respective low-density lipoprotein cholesterol (LDL-C) goals. This definition, however, do not consider the population distribution of non-HDL-C, which could represent a more appropriate individual goal when both markers are discordant. The aim of this study is to establish non-HDL-C goals at the same population percentiles of LDL-C.

Methods: Non-HDL-C values were assigned at the same percentiles correspondent to the LDL-C treatment goals for 14,837 participants from the Longitudinal Study of Adult Health (ELSA-Brasil) with triglycerides levels ≤ 400 mg/dL (4.52 mmol/L). We also assessed the frequency of reclassification, defined as the number of subjects with LDL-C levels in the recommended therapeutic category, but with non-HDL-C levels above or below the category.

Results: The non-HDL-C values, based on correspondent LDL-C population percentiles, were 92 (2.38), 122 (3.16), 156 (4.04), 191 (4.95), and 223 mg/dL (5.78 mmol/L). Among participants with LDL-C <70 mg/dL (1.81 mmol/L), 22.8% were reclassified in a higher category according to the guidelines-based non-HDL-C cut-off and 30.1% according to the population percentile-based cut-off; 25.6% and 64.1%, respectively, if triglycerides concurrently 150-199 mg/dL (1.69-2.25 mmol/L).

Conclusions: Our results demonstrated that non-HDL-C percentiles-based goals were up to 8 mg/dL (0.21 mmol/L) lower than the guidelines recommended goal and had a profound impact on the reclassification of participants, notably when LDL-C was <100 mg/dL (2.56 mmol/L), the treatment goal for high risk patients. Therefore, non-HDL-C goals should be changed for reduction of residual risk.

Keywords: Cardiovascular disease; LDL cholesterol; Non-HDL cholesterol; Population percentiles; Treatment goals.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Anticholesteremic Agents / therapeutic use*
  • Biomarkers / blood
  • Brazil / epidemiology
  • Cholesterol, LDL / blood*
  • Clinical Decision-Making
  • Comorbidity
  • Dyslipidemias / blood
  • Dyslipidemias / diagnosis
  • Dyslipidemias / drug therapy*
  • Dyslipidemias / epidemiology
  • Female
  • Health Status
  • Humans
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Practice Guidelines as Topic
  • Risk Assessment
  • Risk Factors
  • Treatment Outcome


  • Anticholesteremic Agents
  • Biomarkers
  • Cholesterol, LDL