OLYMP Clinical Diagnostic Laboratories

Celiac disease (gluten enteropathy) is a chronic disease of autoimmune genesis caused by eating gluten, which carries HLA-DQ2 and/or -DQ8 alleles, therefore this disease can be transmitted genetically.

When the body is intolerant to gluten, there is a specific lesion of the walls of the small intestine, leading to atrophy of its villi, which is characterized by symptoms such as abdominal bloating, vomiting, weight loss. It is important to note that in most cases celiac disease can proceed without intestinal manifestations, and for this reason 1 out of 4 patients remained without a confirmed diagnosis. However, since the identification of specific markers of celiac disease, the presence of antibodies against tissue transglutaminase and deaminated gliadin peptides, the prevalence of celiac disease has been much higher than anticipated. According to the WHO, the global prevalence of gluten intolerance is 1% of the world's population.

Diagnosis of Celiac Disease Without Biopsy

Until 2012, a biopsy of the small intestine, followed by confirmation of intestinal wall atrophy, was a mandatory requirement for the diagnosis of celiac disease. However, according to recent controversial guidelines, the diagnosis can be made without biopsy in certain circumstances, especially in children. 

Over the past decade, the unambiguity of histological analysis has been questioned and a strong correlation between levels of tissue transglutaminase antibody titer and the severity of mucosal lesions has been recognized.

In 2012, the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) published new diagnostic criteria for celiac disease that allows the diagnosis of celiac disease without biopsy with symptoms and levels of immunoglobulin A against tissue transglutaminase which is 10 or more times the upper limit of normal.

Evidence in favor of this approach has been largely based on small studies.

The results of the ProCeDE diagnostic study show that the non-biopsy ESPGHAN approach allows a correct diagnosis of celiac disease. At least 50% of patients in clinical practice will benefit from this non-biopsy approach, which reduces the burden and risks of endoscopy for small bowel biopsy and anesthesia, while saving costs for health care systems.

Based on the results, it can be concluded that the new ESPGHAN diagnostic criteria for skipping biopsy allow a correct diagnosis of celiac disease in symptomatic children if tissue transglutaminase IgA levels are 10 or more times the upper normal limit, and therefore biopsy is not necessary in these children.

Cardiovascular disease (CVD) remains the leading cause of death worldwide, and the lipid profile, particularly cholesterol levels, plays a key role in its development. For many years, the emphasis has been on determining total cholesterol, low-density lipoprotein (LDL) and high-density lipoprotein (HDL). However, in recent years, increasing attention has been paid to non-HDL cholesterol, a new but promising indicator.

What is non-HDL cholesterol and how does it differ from other indicators?

Non-HDL cholesterol is a calculated parameter that reflects the total cholesterol content of all blood lipoproteins except HDL. It includes cholesterol found in LDL, intermediate density lipoproteins (IDL) and very low density lipoproteins (VLDL). Unlike the traditional LDL assessment, non-HDL cholesterol more fully reflects the atherogenic potential (ability to form plaques) of lipids.

Why is non-HDL cholesterol important?

• More complete risk assessment: Studies show that non-HDL cholesterol may be a more accurate predictor of CVD risk than LDL, especially in patients with elevated triglyceride levels. This is because it takes into account atherogenic particles that LDL does not cover.
• Convenience of calculation: No additional tests are required to determine the level of non-HDL cholesterol. It is calculated by simply subtracting the HDL level from the total cholesterol level.
• Fewer limitations: In some cases, LDL levels may be difficult or unreliable to measure, while non-HDL cholesterol remains a reliable indicator.

Studies supporting the significance of non-LDL cholesterol:

Multiple scientific papers support the significance of non-HDL cholesterol in assessing CVD risk due to its:

• Prognostic value: Studies have shown that high levels of non-HDL cholesterol are associated with an increased risk of myocardial infarction, stroke, and other cardiovascular events.
• Relationship to atherosclerosis: Non-HDL cholesterol is involved in the development of atherosclerosis because the atherogenic particles it comprises readily penetrate the vessel walls and form plaques.
• Efficacy in treatment monitoring: Studies demonstrate that lowering non-HDL cholesterol levels as a result of hypolipidemic therapy correlates with a reduced risk of cardiovascular events.

Clinical application:

An increasing number of clinical guidelines now recommend the use of non-HDL cholesterol in addition to traditional measures of lipid profile, especially in patients with:

• Diabetes mellitus
• Metabolic syndrome
• High triglyceride levels
• Family history of early CVD.

How to interpret non-HDL cholesterol values?

Recommended non-HDL cholesterol values depend on the patient's overall cardiovascular risk:

• Low and moderate risk: Desirable level < 3.8 mmol/L
• High risk: Desirable level < 2.6 mmol/L
• Very high risk: Desirable level < 2.2 mmol/L

Conclusion:

Non-HDL cholesterol is a promising marker of cardiovascular risk that complements traditional lipid profile indices. Its use allows for more accurate risk stratification, especially in patients with CVD risk factors, and effective monitoring of hypolipidemic therapy. Further studies continue to investigate its role in the development of CVDs, but it can already be said that non-HDL cholesterol deserves the attention of physicians and patients concerned about their heart health.

Important: This article is for informational purposes only and is not a substitute for consulting a physician. Please consult a qualified specialist for diagnosis and treatment of cardiovascular diseases.