Journal List > Lab Med Online > v.1(3) > 1057120

van Deventer, Miller, Myers, Sakurabayashi, Bachmann, Caudill, Dziekonski, Edwards, Kimberly, Korzun, Leary, Nakajima, Nakamura, Shamburek, Vetrovec, Warnick, and Remaley: Translation: Non-HDL Cholesterol Shows Improved Accuracy for Cardiovascular Risk Score Classification Compared to Direct or Calculated LDL Cholesterol in a Dyslipidemic Population*

Abstract

Background

Our objective was to evaluate the accuracy of cardiovascular disease (CVD) risk score classification by direct LDL cholesterol (dLDL-C), calculated LDL cholesterol (cLDL-C), and non-HDL cholesterol (non-HDL-C) compared to classification by reference measurement procedures (RMPs) performed at the CDC.

Methods

Weexamined 175 individuals, including 138 with CVD or conditions that may affect LDL-C measurement. dLDL-C measurements were performed using Denka, Kyowa, Sekisui, Serotec, Sysmex, UMA, and Wako reagents. cLDL-C was calculated by the Friedewald equation, using each manufacturer's direct HDL-C assay measurements, and total cholesterol and triglyceride measurements by Roche and Siemens (Advia) assays, respectively.

Results

For participants with triglycerides <2.26 mmol/L (<200 mg/dL), the overall misclassification rate for the CVD risk score ranged from 5% to 17% for cLDL-C methods and 8% to 26% for dLDL-C methods when compared to the RMP. Only Wako dLDL-C had fewer misclassifications than its corresponding cLDL-C method (8% vs 17%; P<0.05). Non-HDL-C assays misclassified fewer patients than dLDL-C for 4 of 8 methods (P<0.05). For participants with triglycerides ≥2.26 mmol/L (≥200 mg/dL) and <4.52 mmol/L (<400 mg/dL), dLDL-C methods, in general, performed better than cLDL-C methods, and non-HDL-C methods showed better correspondence to the RMP for CVD risk score than either dLDL-C or cLDL-C methods.

Conclusions

Except for hypertriglyceridemic individuals, 7 of 8 dLDL-C methods failed to show improved CVD risk score classification over the corresponding cLDL-C methods. Non-HDL-C showed overall the best concordance with the RMP for CVD risk score classification of both normal and hypertriglyceridemic individuals.

Figures and Tables

Fig. 1
Misclassification rate for CVD risk for those participants with TG levels <2.26 mmol/L (200 mg/dL), N=145.
Percent of test results that were classified into either a higher (shaded bar) or lower (hatched bar) CVD risk category compared to RMPs are shown for dLDL-C (A), cLDL-C (B), or non-HDL-C (C). De, Denka; Ky, Kyowa; Ro, Roche; Sr, Serotec; Sk, Sekisui, Sy, Sysmex; Um, UMA; Wa, Wako.
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Table 1
dLDL-C and cLDL-C vs rLDL-C
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acLDL-C was calculated using direct HDL-C from each indicated manufacturer.

Table 2
dHDL-C vs rHDL-C
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Table 3
Comparison of results and classification based on direct non-HDL-C vs RMP non=HDL-C
lmo-1-121-i003

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