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Cholesterol and coronary heart disease: predicting risks in men by changes in levels and ratios
B Kinosian1, H Glick, L Preiss
1University of Pennsylvania, Philadelphia 19104, USA.
Insights
Changes in cholesterol ratios, specifically total cholesterol/HDL and LDL/HDL, better predict coronary heart disease risk than LDL cholesterol alone. These ratio changes are key indicators for cardiovascular risk assessment.
Area of Science:
- Cardiovascular Medicine
- Lipid Metabolism
- Preventive Cardiology
Background:
- The predictive ability of various cholesterol change measures for coronary heart disease (CHD) risk is not well-established.
- Evaluation of changes in low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and their ratios is crucial for risk assessment.
Purpose of the Study:
- To compare the effectiveness of different cholesterol change metrics in predicting coronary heart disease risk.
- To determine if changes in LDL/HDL and total cholesterol/HDL ratios offer superior risk discrimination compared to LDL cholesterol changes alone.
Main Methods:
- Utilized data from 3641 men in the Lipid Research Clinics Coronary Primary Prevention Trial.
- Analyzed changes in LDL cholesterol, HDL cholesterol, LDL/HDL ratio, and total cholesterol/HDL ratio as predictors of CHD risk.
- Estimated risks associated with cholesterol level changes, independent of treatment group allocation.
Main Results:
- Changes in both LDL and HDL cholesterol were significant predictors of CHD risk (ORs for 10% increase: 1.15 and 0.84, respectively; P < 0.001).
- Changes in LDL/HDL and total cholesterol/HDL ratios demonstrated similar strong predictive ability (ORs for 10% increase: 1.17 and 1.21, respectively; P < 0.0001).
- Cholesterol ratio changes added predictive information to LDL cholesterol changes, whereas LDL cholesterol changes did not add information to ratio changes.
Conclusions:
- Changes in total cholesterol/HDL and LDL/HDL ratios are superior predictors of CHD risk compared to LDL cholesterol level changes alone.
- Percentage changes in these ratios during the initial two months of intervention were among the best risk discriminators.
- Clinical treatment decisions should consider the impact on both LDL and HDL cholesterol, not solely LDL levels.
Background:
Little is known about the relative ability of different measures of change in cholesterol to discriminate coronary heart disease risk. We evaluated this ability for changes in low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, LDL/HDL ratios, and total cholesterol/HDL ratios.
Methods:
We predicted risks of coronary heart disease using data from 3641 men in the Lipid Research Clinics Coronary Primary Prevention Trial. Treating these patients as a cohort, we estimated risks associated with changes in cholesterol levels independent of the patients' randomization group.
Results:
Changes in LDL and HDL cholesterol when used in combination were each significant predictors of coronary heart disease risk (odds ratios [OR] for 10% increases, 1.15 and 0.84, respectively; P < 0.001). Changes in LDL/HDL and total cholesterol/HDL ratios had similar discriminating ability (OR for 10% increases, 1.17 and 1.21, respectively; P < 0.0001). In the best discriminating models, changes in ratios added information about risks to changes in LDL cholesterol, although changes in LDL cholesterol levels failed to add information to changes in ratios.
Conclusions:
Changes in total cholesterol/HDL and LDL/HDL ratios were better predictors of risk for coronary heart disease than were changes in LDL cholesterol levels alone. When assessed as percentage changes averaged during the first two months of intervention, they were among the best discriminators of risk. Clinicians selecting treatments for intervention should include among their considerations the treatment's effect on both LDL and HDL cholesterol rather than their effects on LDL cholesterol levels alone.