Comparison of cardiovascular disease risk associated with 3 lipid measures in Japanese adults

►Preference for direct methods over Friedewald equation to assess LDL level is debated.►There is evidence that suggests non-HDL level may be a stronger predictor of CVD.►Direct comparison of CVD risk associated with these 3 measures has not been examined.►High LDL-F and CVD risk was found despite being in low direct LDL and non-HDL groups.►Direct LDL measure and non-HDL are not sufficient substitutes for Friedewald equation.

BackgroundTo assess dyslipidemia, measurement of low-density lipoprotein cholesterol via either Friedewald equation (LDL-F) or direct assay (LDL-D), and non-high-density lipoprotein cholesterol (non-HDL-C) are recommended with some guidelines showing preference to direct over calculated measurements. However, direct comparisons of their respective associations with cardiovascular disease (CVD) risk are currently unavailable.ObjectiveIn this study, we evaluated the clinical effectiveness of LDL-F and non-HDL-C vs LDL-D and their associations with CVD.MethodsThis retrospective cohort study comprised apparently healthy Japanese individuals who underwent an annual health check-up between 2005 and 2007 and completed a 5-year follow-up visit. The incidence of CVD, including coronary and cerebrovascular diseases, during a 5-year follow-up period was evaluated using multivariate logistic regression.ResultsAt baseline, 26,739 participants (mean age, 47 years; 49.0% men) were enrolled, and 292 (1.09%) incidents of CVD were identified at follow-up. Baseline LDL-F, LDL-D, and non-HDL-C were all significantly associated with CVD, although the effect appeared higher for LDL-F, particularly for coronary heart disease. Increased risks of CVD were observed for high LDL-F (≥130 mg/dL), despite being categorized into the lower LDL category based on LDL-D (odds ratio [OR], 1.85; 95% confidence interval [CI], 1.19-2.87) and non-HDL-C (OR, 1.75; 95% CI, 1.22-2.52). Without high LDL-F, no CVD associations were found for high LDL-D (P = .62) or non-HDL-C (P = .93).ConclusionDespite growing availability of direct assays and increasing evidence of non-HDL-C utility, the Friedewald equation may offer better clinical utility for CVD prevention, especially in the screening of apparently healthy individuals.