Because non-HDL cholesterol is considered to be the second lipid target after LDL cholesterol, this meta-analysis investigated the relationship between non-HDL cholesterol and coronary heart disease (CHD) risk in various lipid-modifying therapies. The decreases in non-HDL cholesterol were 17-39% in statin trials, 6-16% in fibrate trials and 7-39% in niacin trials. In statin trials, each 1% decrease in non-HDL cholesterol levels resulted in an estimated relative risk of 0.99 (95% Bayesian CI: 0.98-1.00) during the mean follow-up of 4.5 years. The relationship between non-HDL cholesterol and CHD risk reduction was similar for fibrate trials. However, the niacin model was different from the statin model, except in the study where niacin was used as monotherapy and in which the relationship between non-HDL cholesterol and CHD was 1:1. Finally, the relationship between non-HDL cholesterol and CHD risk in the diet, bile acid sequestrants and surgery trials was also 1:1. Overall, most lipid-modifying drugs used as monotherapy appear to have a 1:1 relationship between percent non-HDL cholesterol lowering and CHD reduction.
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