Position paperNon-high-density lipoprotein cholesterol versus low-density lipoprotein cholesterol in clinical practice: ANMCO position paperColivicchi, Furioa; Di Fusco, Stefania Angelaa; Arca, Marcellob; Leggio, Massimoa; Caldarola, Pasqualec; Murrone, Adrianod; Valente, Serafinae; Urbinati, Stefanof; Roncon, Lorisg; Amodeo, Vincenzoh; Aspromonte, Nadiai; Cipriani, Manlioj; Domenicucci, Stefanok; Francese, Giuseppina Maural; Imazio, Massimom; di Uccio, Fortunato Scotton; Di Lenarda, Andreao; Gulizia, Michele Massimol,p; Gabrielli, DomenicoqAuthor Information aClinical and Rehabilitative Cardiology Unit, San Filippo Neri Hospital ASL Roma 1, Rome bDepartment of Translational and Precision Medicine, Sapienza University of Roma, Rome cU.O.C. Cardiologia-UTIC, San Paolo Hospital, Bari dCardilogy-Intensive Care Unit, Ospedali di Città di Castello e Gubbio - Gualdo Tadino, Azienda USL Umbria 1, Perugia eCardiology Department, Le Scotte University Hospital, Siena fCardiology Unit, Bellaria Hospital, AUSL of Bologna, Bologna gCardiology Unit, Ospedale Santa Maria della Misericordia, Rovigo hCardilogy-Intensive Care Unit, Santa Maria degli Ungheresi Hospital, Polistena, Reggio Calabria iDepartment of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome jCardiology Unit 2, ASST Grande Ospedale Metropolitano Niguarda Cà Granda, Milan kCardiology Unit, ASL 3, Ospedale Padre A. Micone, Genova lCardiology Division, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione ‘Garibaldi’ Catania, Catania mCardilogy Unit, Presidio Molinette, A.O.U. Città della Salute e della Scienza di Torino, Torino nCardiologia-UTIC-Emodinamica, Ospedale del Mare, Napoli oCardiovascular Center, University Hospital and Health Services of Trieste, Trieste pPresidente Fondazione per il Tuo cuore, Heart Care Foundation, Florence qDivision of Cardiology, Augusto Murri Hospital, Fermo, Italy Correspondence to Stefania Angela Di Fusco, MD, Clinical and Rehabilitative Cardiology Unit, San Filippo Neri Hospital, via Martinotti 20, 00135 Rome, Italy E-mail: [email protected] Received 11 September, 2020 Revised 25 November, 2020 Accepted 6 January, 2021 Journal of Cardiovascular Medicine: August 2021 - Volume 22 - Issue 8 - p 609-617 doi: 10.2459/JCM.0000000000001175 Buy Metrics Abstract Bloodstream cholesterol is a central contributor to atherosclerotic cardiovascular diseases. For several decades, low-density lipoprotein cholesterol (LDL-C) has been the main biomarker for the prediction of cardiovascular events and therapeutic target of lipid-lowering treatments. More recently, several findings have supported the greater reliability of non-high-density lipoprotein cholesterol (non-HDL-C) as a predictive factor and possible therapeutic target in refining antiatherogenic treatments, especially among patients with lower LDL-C and higher triglyceride values. This article discusses the limits of current standard methods for assessing LDL-C levels and emphasizes the persistent residual cardiovascular risk in patients treated with lipid-lowering agents on the basis of recommended LDL-C targets. It highlights that patients with controlled LDL-C and non-targeted non-HDL-C have a higher cardiovascular risk. The article focuses on the role of non-HDL-C as a better predictor of atherosclerotic disease as compared with LDL-C and as a therapeutic target. Finally, this article includes an executive summary aimed at refining preventive approaches in atherosclerotic cardiovascular disease. © 2021 Italian Federation of Cardiology - I.F.C. All rights reserved.