Gas station without pumps

2012 March 28

Non–HDL cholesterol level and statins

Filed under: Uncategorized — gasstationwithoutpumps @ 18:59
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A meta-analysis was just published in the Journal of the American Medical Association, Association of LDL Cholesterol, Non–HDL Cholesterol, and Apolipoprotein B Levels With Risk of Cardiovascular Events Among Patients Treated With Statins, March 28, 2012, Boekholdt et al. 307 (12): 1302 — JAMA, that suggests setting statin dosage by the non-HDL cholesterol, rather than LDL, as is more commonly done.

They looked at a number of studies and tried to determine the effect (in terms of increase in cardiovascular “events” per standard deviation change) for three measures: LDL cholesterol, non-HDL cholesterol, and apolipoprotein B.  They found that non-HDL cholesterol was the best predictor of risk (hazard ratio of 1.16 per standard deviation, compared to 1.13 for LDL cholesterol and 1.14 for apolipoprotein B). That means for each standard deviation of increase in non-HDL cholesterol, there is a 16% higher chance of a major cardiovascular event (which includes myocardial infarctions, strokes, and  unstable angina).

I looked at my own LDL and non-HDL levels from my most recent blood tests and saw that I was near the average of the top quartile for both, making my hazard ratio (relative to the bottom quartile) 1.26 based on LDL and 1.42 based on non-HDL.  That means I have about a 42% higher chance of a stroke or heart attack than someone with the same age, gender, body mass index, … whose non-HDL levels were in the bottom quartile.

What I don’t know is whether more aggressive statin therapy is warranted in my case.  How does the increased risk of liver or muscle damage from higher doses of statins compare to decreased risk of heart attack or stroke?  Other than the inherited high cholesterol levels, the only risk factors I have are being male and over 55—I get a fair amount of aerobic exercise, don’t smoke, am not overweight, and don’t have high blood pressure.  According to online cardiac-risk factor calculators, my risk of a heart attack (or death from coronary heart disease) in the next 10 years is 8%–12% (depending on which calculator I use and what it considers).  Small changes in cholesterol (about what is achievable based on my 20 years of statin usage) can move me more solidly into the 8% risk category, but not really reduce the risk lower than that.  If the calculations were based on non-HDL cholesterol, they might assess my risk slightly higher.



  1. There is relative risk and absolute risk. Overall, if you take a statin your absolute risk could be more accurately presented that you will die at 79 without, 80 with , but your side effects may limit the increased dosage. The study does not address mortality, what we really want is to live longer with a good quality of life. Also not mentned is that other causes of death come into play as we age. Half of the people who have a cardiac event have normal cholesterol. Alternatively, many with high LDL and total cholesterol do not have cardiac events. Cholesterol and LDL aren’t the total story.

    Comment by Barbara de la pena — 2012 March 30 @ 07:24 | Reply

  2. As you say, your profile doesn’t real seem like that of a heart disease risk. I think looking at how you can solve the problem naturally should always be the first choice of action in most circumstances. Exercise and diet could solve most of the western world’s health problems including ‘bad’ cholesterol and heart disease.

    Comment by Pauline — 2012 April 4 @ 07:09 | Reply

    • I tried for a year a diet that was touted as lowering cholesterol, and I get about as much exercise as I can stand (cycling about 2000 miles a year). Those “natural” interventions did not improve my cholesterol levels sufficiently—statins have been far more effective in my case.

      Comment by gasstationwithoutpumps — 2012 April 4 @ 10:02 | Reply

  3. […] Non – HDL cholesterol level and statins ( 27.773056 -82.640000 Share this:Like this:LikeBe the first to like this post. […]

    Pingback by Health Benefits of Walking « Media Meme — 2012 April 14 @ 15:31 | Reply

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