Targeting residual risk: The rationale for the use of non-HDL cholesterol

There is a wealth of epidemiological and clinical data linking low-density lipoprotein cholesterol (LDLc) with atherosclerotic cardiovascular disease. Numerous primary and secondary prevention trials have demonstrated that reduction in LDLc leads to significant decrease in cardiovascular event rates. However, patients continue to be at significant risk for recurrent events despite aggressive LDLc lowering, reflecting a substantial residual risk. Numerous parameters like apolipoprotein B, LDL particle size, number and non-high density lipoprotein cholesterol (non-HDLc) measurement have been used to assess and address this high residual risk. Herein, we discuss the rationale and the evidence supporting the use of non-HDLc. We also discuss therapeutic options and provide a practical approach to residual risk reduction from a primary care perspective.