Meta-analysis of serum non-high-density lipoprotein cholesterol and risk of coronary heart disease in the general population

Background: Non-high-density lipoprotein cholesterol (non-HDL-C) has been proposed an independent risk factor for coronary heart disease (CHD). However, the magnitude of this association in the general population varied considerably. Objective: To investigate the association of baseline non-HDL-C level with CHD risk in the general population by conducting a meta-analysis. Methods: A comprehensive literature search was performed in the Pubmed and Embase until January 2017. Prospective observational studies that investigated the association between baseline non-HDL-C level and CHD risk in the general population were included. Pooled hazard ratio (HR) and corresponding 95% confidence interval (CI) were calculated for the highest vs. the lowest non-HDL-C category. Results: Seven articles with 9 independent prospective studies involving 448,732 individuals were included. Meta-analysis showed that individuals with the highest non-HDL-C level at baseline were associated with greater risk of CHD (RR 1.79; 95% CI 1.68-1.91) than those in the lowest non-HDL-C level category. Subgroup analysis suggested that the risk of CHD seemed more pronounced among men (HR 1.98; 95% CI 1.70-2.30) than among women (HR 1.63; 95% CI 1.35-1.96). Conclusions: Higher baseline non-HDL-C level is associated with increased risk of CHD in the general population. This risk seems more pronounced in men than in women. However, gender difference in non-HDL-C level associated with CHD risk should be verified by more well-designed prospective studies.