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Framingham Heart Study (FHS), started in 1948, has provided a lot of pivotal results and findings that help us understand and solve problems associated with atherosclerotic disease risk. This FHS found that high levels of low-density lipoprotein-cholesterol (LDL-C) and low levels of high-density lipoprotein-cholesterol (HDL-C) were the causes of coronary heart disease (CHD), and the term “risk factor” also was set up due to the impetus of the FHS evidence. As FHS findings have shown the significant relevance of dyslipidemia to CHD risk, the accurate measurement of LDL-C and HDL-C is of significant importance for the diagnosis of dyslipidemia and assessment of CHD risk without any dispute. LDL-C has been measured in clinical practice using Friedewald formula, which is inapplicable for blood samples of non-fasting individuals or those with ≥400 mg/dL of triglyceride (TG) . There are no significant differences in total cholesterol (TC) levels between fasting and non-fasting states, however, TG usually increases postprandially. The Friedewald formula (TC –HDL-C–TG/5) comes into effect, as the value of TG/5 is nearly equal to that of very low-density lipoprotein-cholesterol. However, LDL-C estimated using the Friedewald formula tends to be lower than that determined using the ultracentrifugation method, if serum TG level is ≥200 mg/dL. Whence, a variety of modified methods with different TG coefficient in the formula have been reported, but most of these modified methods do not necessarily overwhelm the Friedewald formula with regard to accuracy, precision, and convenience of LDL-C estimation. In the meantime, a number of homogeneous assay methods for LDL-C measurement were developed in Japan because the limitations of the Friedewald formula (i.e., requirements of fasting blood samples and serum TG level <400 mg/dL) may interfere with routine clinical assessment of lipid metabolism in patients. Although commercial homogeneous assays have passed the precision and accuracy requirements defined by the National Cholesterol Education Program (NCEP), several earlier studies revealed that some homogenous assays exhibited poor analytical performance in patients with common diseases and even in diseasefree subjects; some of these homogenous assays were thus withdrawn from the Japanese market. Hypertriglyceridemia often provides a plus assay bias in LDL-C measurements, but the homogeneous assays have been expected to be applicable to postprandial samples even with the presence of much TG-rich lipoproteins in contrast to the Friedewald formula 11, . However, the accuracy of homogeneous assays has never been compared between non-fasting and fasting samples using the reference measurement procedures in disease-free and diseased subjects. Miida, et al. demonstrated the availability of LDL-C and HDL-C homogeneous assays in non-fasting samples derived from disease-free and diseased subjects. Fresh blood samples were collected from 59 disease-free and 109 diseased subjects and nonfasting samples constituted 72.9% and 42.9% of these samples, respectively. LDL-C and HDL-C concentrations were measured using homogeneous assays of four manufacturers. These four homogeneous assays for LDL-C and HDL-C met the NCEP requirements in terms of coefficient of variation, indicating that these assays are as accurate for non-fasting samples as for fasting samples in both disease-free and diseased subjects. Japan Atherosclerosis Society guideline recommends the assessment of non-HDL-C (TC–HDLC) instead of LDL-C when using non-fasting samples Determination of Fasting and Non-Fasting Cholesterol Levels of Lowand High-Density Lipoproteins with Homogenous Assays: A Promising Reliable Way to Assessment of Dyslipidemia

journal of atherosclerosis and thrombosis

Determination of Fasting and Non-Fasting Cholesterol Levels of Low- and High-Density Lipoproteins with Homogenous Assays: A Promising Reliable Way to Assessment of Dyslipidemia