Skip to main content

Discordant serum lipid parameters

Dear Editor,

We read with interest the paper by Fonseca et al. entitled “Apolipoprotein B and non-high-density lipoprotein cholesterol reveal a high atherogenicity in individuals with type 2 diabetes and controlled low-density lipoprotein-cholesterol” [1]. The authors state that 22% of the diabetic patients with target low-density lipoprotein cholesterol (LDL-C) level had non-high-density lipoprotein cholesterol (non-HDL-C) level above the target level. Target levels were defined according to the European Society of Cardiology/European Atherosclerosis Society 2016 Guideline for the Management of Dyslipidemia [2].

We previously demonstrated that in 574 consecutive patients who underwent coronary angiography, 15% of them had discordance between LDL-C and non-HDL-C levels [3]; 30% of our study group had type 2 diabetes mellitus (T2DM). In our study, patients with a high difference between non-HDL-C and LDL-C levels were more commonly females, had T2DM and high triglyceride levels [3]. Also, they less commonly received statin therapy [3]. Both the current study [1] and our study [3] measured fasting blood lipids. Measuring apolipoprotein B (Apo B) and oxidized LDL-C level is one of the advantages of the Fonseca et al. study [1]. The authors reported that in addition to non-HDL-C, Apo B and oxidized LDL-C levels were above the recommended range in 25 and 44% of the patients with controlled LDL-C levels, respectively. Non-HDL-C, Apo B and oxidized LDL-C are all potential atherogenic lipid particles [4, 5]. The findings of Fonseca et al. [1] add significant information to previously published data. Comparing the characteristics of patients with non-HDL-C, Apo B and oxidized LDL-C below target with non-HDL-C, Apo B and oxidized LDL-C above target in groups within and above target LDL-C levels separately would be useful for better understanding which patient might have discordant lipid parameters.

Although the size of the study populations and the cut-off values for LDL-C and non-HDL-C to classify patients differ between the current study [1] and our study [3], we both pointed out that sizeable proportion of patients may have low LDL-C and high non-HDL-C levels; T2DM seems to be a risk factor for this pattern. In our study [3], patients with low LDL-C and high non-HDL-C had higher levels of triglycerides than the other patients and high triglyceride levels have been related to discordance of LDL-C and non-HDL-C in previous studies [6, 7]. In the current study [1], there was no significant difference between patients with LDL-C levels within and above target regarding triglyceride levels.

Further studies should be designed to understand the demographic, clinical and laboratory characteristics of patients with discordant lipid parameters. Moreover, the prognosis of cardiovascular disease should be further investigated in follow-up studies in these patients. Despite the low levels of LDL-C, some patients still experience cardiovascular events and patients with low levels of LDL-C but with higher levels of other atherogenic lipid particles may need further evaluation, more aggressive management and close follow-up.

Availability of data and materials

Not applicable.


Apo B:

Apolipoprotein B


low-density lipoprotein cholesterol


non-high-density lipoprotein cholesterol


  1. 1.

    Fonseca L, Paredes S, Ramos H, Oliveira JC, Palma I. Apolipoprotein B and non-high-density lipoprotein cholesterol reveal a high atherogenicity in individuals with type 2 diabetes and controlled low-density lipoprotein-cholesterol. Lipids Health Dis. 2020;19:127.

    CAS  Article  Google Scholar 

  2. 2.

    Catapano AL, Graham I, De Backer G, Wiklund O, Chapman MJ, Drexel H, et al. 2016 ESC/EAS guidelines for the management of dyslipidaemias. Eur Heart J. 2016;37:2999–3058.

    Article  Google Scholar 

  3. 3.

    Kurmus O, Erkan AF, Ekici B, Aslan T, Eren M. Discordance of low-density lipoprotein Cholestrol and non-high-density lipoprotein Cholestrol and coronary artery disease severity. Arq Bras Cardiol. 2020;114:469–75.

    CAS  PubMed  PubMed Central  Google Scholar 

  4. 4.

    Pischon T, Girman CJ, Sacks FM, Rifai N, Stampfer MJ, Rimm EB. Non-high-density lipoprotein cholesterol and apolipoprotein B in the prediction of coronary heart disease in men. Circulation. 2005;112:3375–83.

    CAS  Article  Google Scholar 

  5. 5.

    Kattoor AJ, Kanuri SH, Mehta JL. Role of ox-LDL and LOX-1 in Atherogenesis. Curr Med Chem. 2019;26:1693–700.

    CAS  Article  Google Scholar 

  6. 6.

    Kuwabara K, Harada S, Sugiyama D, Kurihara A, Kubota Y, Higashiyama A, et al. Relationship between non-high-density lipoprotein cholesterol and low-density lipoprotein cholesterol in the general population. J Atheroscler Thromb. 2016;23:477–90.

    CAS  Article  Google Scholar 

  7. 7.

    Mora S, Buring JE, Ridker PM. Discordance of low-density lipoprotein (LDL) cholesterol with alternative LDL-related measures and future coronary events. Circulation. 2014;129:553–61.

    CAS  Article  Google Scholar 

Download references


Not applicable.



Author information




OK: major contributor in writing the letter. OK, TA, ME, KA, read and interpreted the article which was previously published in Lipids in Health and Disease journal. All the authors read and approved the final version of the letter.

Corresponding author

Correspondence to Ozge Kurmus.

Ethics declarations

Ethics approval and consent to participate

Not applicable (This is a “letter to the editor”).

Consent for publication

Not applicable.

Competing interests


Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Kurmus, O., Aslan, T., Eren, M. et al. Discordant serum lipid parameters. Lipids Health Dis 20, 10 (2021).

Download citation