These two indices can be regarded as similar; since two thirds of plasma cholesterol are found in LDL, total and LDL cholesterol are closely correlated. The predictive capacity of these ratios is supported by data suggesting that an increase in HDL cholesterol is more prevalently associated with plaque regression, while a decrease in LDL cholesterol would slow down progression.
Both predict greater cardiovascular risk for a wide range of cholesterol concentrations. This may be particularly interesting in patients with features of the metabolic syndrome. We suggest that future recommendations regarding the diagnosis and treatment of dyslipidemia, including instruments for calculating cardiovascular risk or action guidelines, should include the lipoprotein ratios with greater predictive power which, in view of the results, are none other than those which include HDL cholesterol.
Meanwhile, we propose that lipoprotein ratios should be routinely determined to assess the atherogeneity lipids disorders, mainly those characterized by an elevation in plasma triglycerides.
National Center for Biotechnology Information , U. Vasc Health Risk Manag. Author information Copyright and License information Disclaimer. This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited. This article has been cited by other articles in PMC.
Abstract Low-density lipoprotein LDL cholesterol concentration has been the prime index of cardiovascular disease risk and the main target for therapy. Keywords: apolipoproteins, cholesterol ratios, predictive power, cardiovascular disorders.
Introduction Estimation of cardiovascular risk has become the cornerstone of cardiovascular prevention. Open in a separate window. Figure 1. Figure 2. Abbreviation: Apo, apolipoproteins. What do lipoprotein ratios provide that other conventional risk variables do not?
Conclusions and recommendations LDL cholesterol concentration has been the prime index of cardiovascular disease risk and the main target for therapy. Footnotes Disclosures The authors report no conflicts of interest in this work.
References 1. Superko HR, King S. Coronary calcification, coronary disease risk factors, C-reactive protein, and atherosclerotic cardiovascular disease events: the St. Francis Heart Study. J Am Coll Cardiol. Management of dyslipidemia in the metabolic syndrome. Am J Cardiovasc Drugs.
Cholesterol and coronary heart disease: predicting risks by levels and ratios. Ann Intern Med. The ILIB lipid handbook for clinical practice: blood lipids and coronary heart disease. Recommendations for the management of dyslipidemia and the prevention of cardiovascular disease: update. According to the same study, a 4. Heart disease risk for women doubles if their ratio is 7 , while a ratio of 3. Two people with the same total cholesterol number can have different cholesterol ratios.
The ratios indicate different levels of heart disease risk. Harvard Medical School cites the following example: If your total cholesterol is and your HDL is 60, your cholesterol ratio would be 3. However, if your HDL is 35 — below the recommended level of 40 for men and 50 for women — your cholesterol ratio would be 5. This ratio places you in a higher risk category. Some people may find it easier to remember their cholesterol ratio — one number — than their HDL, LDL, and total numbers.
Knowing your total cholesterol and the risk indicated by your cholesterol ratio helps you set the appropriate goals to keep your numbers in a healthy range. The AHA believes that absolute numbers for total blood cholesterol and HDL cholesterol are more effective than a ratio in determining cholesterol-lowering treatment. But both are useful in looking at your overall risk.
If your total cholesterol level is high, your doctor will also look at the ratio of your total cholesterol to HDL. If that number is below 5 for a man or 4. Your cholesterol ratio clarifies the picture of your risk of heart disease. Oxidized LDL has a low affinity for macrophage scavenger receptors, and, thereby, oxidized LDL enters the blood circulation stimulating adhesion molecules and chemokines.
Oxidized LDL can be taken up by macrophages through the scavenger receptors, leading to the formation of foam cells This cascade leads to initiation and progression of atherosclerosis in coronary arteries, which is an underlying cause of SCD In a postmortem study of SCDs, elevated LDL-c levels were shown to be correlated with the severity of coronary atherosclerosis It has also been shown that plasma lipid and lipoprotein levels are significantly elevated in SCD cases Among the LDL-c subclasses which differ in physiochemical properties and atherogenecity 34 , small, dense LDL are regarded as more atherogenic than large LDL particles 35 , Non-HDL-c, which can easily be estimated from routine lipid panels, has been suggested to be a surrogate marker of small, dense LDL-c For HDL-c, there is a growing body of evidence which supports the concept that the functional properties of HDL-c rather than circulating levels, may be more important in determining CHD risk Very high levels of HDL-c have also been demonstrated not to be associated with the risk of vascular events Indeed, the evidence suggests that enhancing HDL-c function rather than increasing its levels, is associated with clinical benefit Rupture of high-risk vulnerable plaques is considered to be the major pathway in the development of coronary thrombosis, which eventually leads to acute MI and SCD Coronary heart disease is the most common pathology underlying SCD 47 , Though the findings may partly reflect undiagnosed CHD, other pathways such as chronic inflammation may be involved.
Assays for these lipoproteins are already being used in clinical practice to predict CVD risk in patients. Estimation of the ratio may have the potential to be used in the identification of individuals at high risk for SCD. However, further studies are needed to unequivocally establish this potential preventive strategy.
The strengths and limitations of the current study merit consideration. Strengths include its prospective population-based design, complete and long follow-up period, assessment of a comprehensive range of potential confounders, which enabled reliable assessments of the associations.
Our representative sample makes it possible to generalize the observed results to male Caucasian populations, which was the primary focus of the study design; however, these results need to be replicated in female populations. The assessment of baseline clinical conditions by self-administered questionnaires is a limitation of the study.
Further, we could not correct for regression dilution bias, which may have underestimated the observed associations, as we had only one-time assessment of lipid profiles, which may have changed during follow-up because of the probable changes in health habits or medication of participants over the time.
Though many potential confounders were measured and carefully adjusted to ensure the validity of our key findings, there was still a potential for residual confounding owing to unmeasured risk factors.
Further studies are needed to replicate these associations and assess the mechanistic pathways underlying the relationships. The authors report no relationships that could be construed as a conflict of interest. National Center for Biotechnology Information , U. J Proteome Res. The effect of age and risk factors on coronary and carotid artery atherosclerotic burden in males-results of the Heinz Nixdorf recall study.
The different facets of dyslipidemia and hypertension in atherosclerosis. Curr Atheroscler Rep. Download references. The authors thank all the doctors and nurses at the physical examination center of Xiaotangshan Hospital for collecting the data. The outstanding youth talent support program for training excellent talents in Fangshan District, Beijing, China No. You can also search for this author in PubMed Google Scholar. Only health examination information data was used for data analysis, so the requirement of informed consent from participants was waived.
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Reprints and Permissions. Lou, Y. LDL-cholesterol to HDL-cholesterol ratio discordance with lipid parameters and carotid intima-media thickness: a cohort study in China. Lipids Health Dis 19, Download citation. Received : 26 February Accepted : 12 June Published : 18 June Anyone you share the following link with will be able to read this content:.
Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative. Skip to main content. Search all BMC articles Search. Download PDF. Results During 37, person-years of follow-up, individuals men and women developed elevated CIMT. Introduction Carotid intima-media thickness CIMT , an alternative indicator of subclinical atherosclerosis, can predict future ischemic cardiovascular disease CVD and stroke events [ 1 , 2 , 3 , 4 , 5 ].
Carotid artery color Doppler ultrasound A 3. Covariate assessment At baseline and at every follow-up, information on age; sex; medical history of CVD, stroke and cancer; and use of medications was collected from all participants. Results During 37, person-years of follow-up, individuals men; women developed elevated CIMT; the incidence rates per person-years were Availability of data and materials All data generated or analyzed during this study are included in this published article and its supplementary information files.
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