Importance and Management of Non–High-Density Lipoprotein Cholesterol in Dyslipidemia Treatment

Residual cardiovascular (CV) risk persists despite achieving low-density lipoprotein cholesterol (LDL-C) targets with lipid-lowering therapy, indicating the role of other lipid parameters. Robust evidence has shown that non-high-density lipoprotein cholesterol (non-HDL-C) confers better estimation of atherosclerotic cardiovascular disease risk than LDL-C and is increasingly recognized as a treatment target in atherogenic dyslipidemia. Whereas global guidelines have incorporated non-HDL-C as a primary or co-primary lipid target, most Asia-Pacific region (APAC) guidelines still consider it secondary to LDL-C. To address this gap, we developed a consensus document with evidence-based recommendations with the use of a modified Delphi method involving 11 experts across 10 APAC countries. This offers practical guidance on adopting non-HDL-C as a lipid target, including add-on therapies to statins for reducing non-HDL-C and CV risk in atherogenic dyslipidemia. Acknowledging regional variations in lipid targets, this document does not override local APAC guidelines but rather encourages physicians to manage non-HDL-C in alignment with those guidelines.