Importance of measuring Non-HDL cholesterol in type 2 diabetes patients

Objective: to study the correlation between non-high-density lipoprotein and low-density lipoprotein cholesterol in patients with type 2 diabetes mellitus and the proportion of patients achieving adult treatment panel iii recommended goals. methods: the cross sectional study was conducted at the diabetic clinic, aga khan university hospital, karachi. data of type 2 diabetes mellitus patients who attended the clinic bewteen 2007 and 2011 was reviewed. all type 2 diabetic patients of either gender with fasting lipid profile irrespective of taking lipid lowering therapy were included. type-1 dm, gestational diabetes, type 2 diabetes patients with pregnancy and those with incomplete data were excluded. correlation between the low-density lipoprotein and non- high-density lipoprotein was assessed by applying cramer v and phi. proportion of patients achieving adult treatment panel iii recommended goals was checked. multivariable regression was done to identify common factors associated with elevated non- high-density lipoprotein cholesterol. results: a total of 1352 patients fulfilling the eligibility criteria were included in the study. mean age of the patients was 54.5±11.3 years; 797 (59%) were males; 1122 (83%) had body mass index above 25; and 1016 (75%) had hba1c >7%. mean non-high-density lipoprotein cholesterol was 129±42mg/dl. mean low-density lipoprotein cholesterol was 100±37mg/dl. both low-density lipoprotein <100 and non-hdl <130 mg/dl was achieved in 645 (48%) patients. it is important to note that although 728 (53.8%) patients achieved target ldl cholesterol of <100mg/dl, among them 83 (11.4%) had non-high-density lipoprotein cholesterol still above the target >130mg/dl (p<0.05). out of 752 patients with non-high-density lipoprotein cholesterol <130mg/dl, 645(86%) had low-density lipoprotein cholesterol below 100mg/dl. cramer v and phi showed that correlation between non-high-density lipoprotein and low-density lipoprotein cholesterol was 0.71 (pvalue<0.01). after adjusting for other covariates, low-density lipoprotein cholesterol >100mg/dl was independently associated with having non-high-density lipoprotein cholesterol >130mg/dl (adjusted odds ratio 38.6; 95% confidance interval = 28.1-53.1). similarly, age <60 years was 60% more likely to have non-high-density lipoprotein cholesterol> 130 mg/dl (adjusted odds ratio 1.6; 95% confidance interval = 1.01 - 2.3). whereas having obesity body mass index >25 was 3.6 times more associated to have non-high-density lipoprotein >130mg/dl (adjusted odds ratio 3.6; 95% confidance interval = 1.6-7.7). in patients with coronary artery disease, combined goal achievement of low-density lipoprotein <70mg/dl and nonhigh- density lipoprotein cholesterol <100mg/dl was seen in 59(35%). among patients with high-density lipoprotein <70mg/dl, 8(10%) had non-high-density lipoprotein >100mg/dl (p <0.05). conclusion: the study showed a correlation between non-high-density lipoprotein and low-density lipoprotein cholesterol. as measuring non-high-density lipoprotein cholesterol in type 2 dm patients is simple, cost-effective and convenient because it does not require 12-hour fasting which may be a risk for hypoglycaemia in these patients, clinicians may choose non-high-density lipoprotein as a routine measure in everyday practice.