The atherogenic and metabolic impact of non-HDL cholesterol versus other lipid sub-components among non-diabetic and diabetic Saudis

BACKGROUND: Several trials from different populations have reported that non-high density lipoprotein cholesterol (non-HDL-C) has more predictive power than low-density lipoprotein cholesterol (LDL-C) in detecting coronary heart disease (CHD) and none in any Arab community whose propensity to develop CHD is higher compared to other ethnicities. This study aims to determine and compare the impact of non-HDL-C versus other lipid parameters, in predicting coronary heart disease among diabetic versus non-diabetic adult Saudis and identify the lipid parameters which make a significant contribution in the development of coronary heart disease, diabetes mellitus, and metabolic syndrome. 733 adult Saudis were recruited and divided into groups of diabetics and non-diabetics. Each participant completed a questionnaire, underwent physical exam including 12-L ECG, and submitted a fasting blood sample where glucose and lipid parameters were analyzed using routine procedures. RESULTS: 462 subjects (age 45.03 ± 11.52; BMI 28.91 ± 6.07) were classified non-diabetics while the remaining 271 (age 52.73 ± 11.45, BMI 30.15 ± 6.62) were diabetics. 99 out of 465 (21.3%) of non-diabetics had CHD and 114 out of 271 (52.5%) in the diabetics. Non-HDL cholesterol was the best predictor among the non-diabetics (odds-ratio 2.89, CI 1.10–7.58, p-0.03). Total cholesterol was the highest single predictor for the development of CHD among the lipids (odds-ratio 1.36, CI 0.68–2.71, p-0.39) but HDL-cholesterol although small was significant (odds-ratio 0.52, CI 0.27–0.99, p-0.05). CONCLUSION: This study supports the use of non-HDL cholesterol as the more practical and reliable target for lipid lowering therapy among the Saudi population.