Original article| Volume 113, ISSUE 3, P325-334, March 1989

Cholesterol guidelines, lipoprotein cholesterol levels, and triglyceride levels: Potential for misclassification of coronary heart disease risk

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      By using National Cholesterol Education Program guidelines for serum cholesterol (<200 mg/dl is designated “desirable,” and 200 to 239 mg/dl is designated “borderline-high,” and ≥240 mg/dl is designated “high”), low-density and high-density lipoprotein (LDL, HDL) cholesterol levels and triglyceride levels were quantitated in 897 self-referred fasting subjects to assess the potential for coronary risk misclassification. With cholesterol <200 mg/dl, misclassification was arbitrarily identified by an LDL level ≥ the 75th percentile, a triglyceride level ≥ the 90th percentile, or an HDL level ≤ the 10th percentile. With the cholesterol level in the 200 to 239 mg/dl range, misclassification was identified by an LDL level ≥ the 75th percentile, a triglycéride level ≥ the 90th percentile, and an HDL level ≤ the 10th percentile or ≥ the 90th percentile (or both). With a cholesterol level ≥240 mg/dl, misclassification was identified by an HDL level ≤ the 10th percentile, or ≥ the 90th percentile. With the cholesterol level <200 mg/dl, misclassification is rare, occurring in 14.5% of the subjects. With the cholesterol level in the 200 to 239 mg/dl range, and ≥240 mg/dl, misclassification occurred in 46.7% and 17.6% of the subjects, respectively. The importance of routine lipoprotein analysis when the cholesterol level is ≥240 mg/dl is emphasized by the finding that 65% of the subjects in this category had top quartile LDL levels, 8% had bottom decile HDL levels, and 30% had top decile triglyceride levels. To avoid misclassification, fasting HDL, LDL, and triglyceride levels should probably be measured in all subjects with screening cholesterol levels ≥200. There is remarkably little misclassification with top quartile LDL or bottom decile HDL levels (or both) when the cholesterol level is <200 mg/dl.


      CHD = coronary heart disease (), HDL = high-density lipoprotein (), LDL = low-density lipoprotein (), TC = total serum cholesterol ()
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