Weighing in Before the Fight Low-Density Lipoprotein Cholesterol and Non–High-Density Lipoprotein Cholesterol Versus Apolipoprotein B as the Best Predictor for Coronary Heart Disease and the Best Measure of Therapy

In this issue of Circulation , Pischon and colleagues1 present provocative data pitting the power of non–high-density lipoprotein cholesterol (non-HDL-C) versus apolipoprotein (apo) B to predict coronary heart disease (CHD) development in healthy men. They conclude not only that apoB is a superior predictor of CHD risk but, in addition, that “the practical application of our findings would be the substitution of apoB for LDL-C and non-HDL-C for screening and treatment of CHD risk.” Article p 3375 The article presents a healthy spar—a bob and weave—between apoB and the cholesterol concentrations in apoB-containing lipoproteins. The contenders could be fraternal twins because they are strikingly similar. They may be conjoined, making any competition between parts more akin to self-mutilation. This coveted prize must be earned by more than a simple sparring competition. Guidelines for lipid management are not valuable unless the measurement of the indicator variable can be made reliably and reproducibly. The present standards for total cholesterol (TC) and HDL-C are a bias ≤3% and ≤5% (accuracy) with a coefficient of variation (CV) ≤3% and ≤4% (precision) with a total error of ≤8.9% and ≤13%, respectively.2 Before the mid-1980s, CVs for apoB averaged 30%. The development of standardized methods and suitable reference standards has led to marked improvements in reliability with an average bias of 2.1% (range −5.0 to 3.8%) and an average CV of 2.6% (range 0.9 to 5.1%).3 These appear to be comparable to that expected for non-HDL-C derived from TC and HDL-C measurements. ### Round 1 Score: 10:10 Both are reliable measurements. Interindividual day-to-day variation in apoB is similar to that found for TC (5% to 7%); calculated LDL-C is higher at 9% and non-HDL-C is probably in a similar range.4 Variation from race and gender finds higher mean non-HDL-C in men than in women (160 versus 154 …