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Epidemiologic aspects of lipid abnormalities
1University of California, San Diego, Department of Family and Preventive Medicine, La Jolla 92093-0607, USA.
Insights
The total cholesterol to high-density lipoprotein cholesterol ratio is the best predictor of cardiovascular disease risk and treatment benefit. This ratio should be emphasized more in research and patient monitoring for dyslipidemia.
Area of Science:
- Cardiovascular Medicine
- Lipidology
- Epidemiology
Background:
- Current cardiovascular disease guidelines prioritize total cholesterol (TC) and low-density lipoprotein (LDL) cholesterol.
- High-density lipoprotein (HDL) cholesterol and triglycerides play lesser roles in current lipid management strategies.
Purpose of the Study:
- To review epidemiologic evidence on the independent predictive value of various lipid factors for cardiovascular disease (CVD).
- To evaluate the predictive power of TC, LDL, HDL, very-low-density lipoprotein (VLDL) cholesterol, triglycerides, LDL particle size, and the TC/HDL ratio.
Main Methods:
- Review of existing epidemiologic evidence on lipid factors and CVD risk.
- Analysis of the independent predictive value of individual lipid parameters and ratios.
- Assessment of predictive value in relation to outcomes and treatment benefits.
Main Results:
- Triglycerides are an independent CVD risk factor in certain populations; postprandial triglycerides may be more predictive than fasting levels.
- LDL particle size lacks independent predictive value when adjusted for triglycerides.
- The TC/HDL-cholesterol ratio is the single most predictive lipid factor for CVD risk and treatment benefit, maintaining its value into older age.
Conclusions:
- The TC/HDL-cholesterol ratio offers superior predictive value for cardiovascular risk and treatment response compared to other lipid parameters.
- Increased emphasis on the TC/HDL-cholesterol ratio is recommended for epidemiologic studies and patient monitoring in dyslipidemia management.
Abstract:
Existing cholesterol guidelines aimed at preventing cardiovascular disease emphasize the role of total cholesterol (TC) and low-density lipoprotein (LDL) cholesterol in lipid management decisions, with a subsidiary role for high-density lipoprotein (HDL) cholesterol in guiding treatment and little role for triglycerides. In this article, epidemiologic evidence is reviewed relating to the independent value of lipid factors in prediction of cardiovascular disease risk, including TC, LDL cholesterol, HDL cholesterol, very-low-density lipoprotein (VLDL) cholesterol and triglycerides, LDL particle size ("pattern B"), and the TC/HDL-cholesterol ratio. Several observations are highlighted. Triglycerides appear to be an independent risk factor in specific populations. Postprandial triglycerides may be superior to fasting triglycerides as a predictor of risk. LDL particle size does not have independent predictive value after adjustment for triglycerides. Particular emphasis is placed on the observation that the single most predictive lipid factor is the TC/HDL-cholesterol ratio, which implicitly incorporates information on both LDL and triglycerides in the numerator. This is the best predictor both of outcome and of treatment benefit, and its predictive value appears to be maintained into older age. It is concluded that increasing emphasis should be placed on the TC/HDL cholesterol ratio in epidemiologic analyses and in monitoring patients on therapy for dyslipidemia.