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Relation between high density lipoprotein cholesterol and coronary artery disease in asymptomatic men
Insights
A high cholesterol to HDL ratio (6.0 or more) strongly indicates coronary artery disease risk in asymptomatic individuals. This finding highlights HDL cholesterol
Area of Science:
- Cardiology
- Preventive Medicine
- Biochemistry
Background:
- High-density lipoprotein cholesterol (HDL) has an established inverse relationship with coronary artery disease (CAD) risk.
- Asymptomatic individuals require effective screening methods for early detection of CAD risk factors.
Purpose of the Study:
- To investigate the association between HDL cholesterol levels and the presence of coronary artery disease in asymptomatic aircrew.
- To evaluate the cholesterol/HDL ratio as a predictor of significant coronary artery disease.
Main Methods:
- Cross-sectional study of 572 asymptomatic aircrew undergoing CAD risk screening.
- Included fasting serum lipid profiles (cholesterol, HDL, triglycerides) and maximal exercise tolerance tests.
- Coronary angiography performed on 132 individuals with abnormal exercise tests or high CAD risk suspicion.
Main Results:
- Significant CAD found in 16 individuals; minimal/subcritical disease in 14.
- A cholesterol/HDL ratio of 6.0 or higher was present in 14 of 16 men with CAD.
- A cholesterol/HDL ratio ≥ 6.0 demonstrated the highest odds ratio (172:1) for CAD among evaluated risk factors.
Conclusions:
- HDL cholesterol levels, particularly the cholesterol/HDL ratio, are valuable in identifying asymptomatic individuals at increased risk for coronary artery disease.
- A cholesterol/HDL ratio of 6.0 or more is a strong indicator of significant coronary artery disease.
Abstract:
The well established inverse relation of high density lipoprotein cholesterol (HDL) and the risk of coronary artery disease was tested in a cross-sectional group of 572 asymptomatic aircrew members who were being screened for risk of coronary artery disease. A battery of tests was performed, including determinations of fasting serum cholesterol, HDL cholesterol and triglycerides and performance of a maximal symptom-limited exercise tolerance test. Of the 572 patients, 132 also had an abnormal S-T segment response to exercise testing or were otherwise believed to have an increased risk of organic heart disease and subsequently underwent coronary angiography. Significant coronary artery disease was found in 16 men and minimal or subcritical coronary disease in 14; coronary angiograms were normal in the remaining 102 men. The remaining 440 men, who were believed to have a 1 percent chance of having coronary artery disease by sequential testing of risk factors and treadmill testing, had a mean cholesterol level of 213 mg/100 ml, a mean HDL cholesterol of 51 mg/100 ml and a mean cholesterol/HDL ratio of 4.4. The mean values of cholesterol, HDL cholesterol and cholesterol/HDL cholesterol did not differ significantly in men with normal angiographic finding and those with subcritical coronary disease. However, 14 of 16 men with coronary artery disease had a cholesterol/HDL ratio of 6.0 or more whereas only 4 men with normal coronary arteries had a ratio of 6.0 or more. Of the classical coronary risk factors evaluated, the cholesterol/HDL ratio of 6.0 or more had the highest odds ratio (172:1). It appears that determination of HDL cholesterol level helps to identify asymptomatic persons with a greater risk of having coronary artery disease.