Cardiovascular risk factor clustering and ratio of total cholesterol to high-density lipoprotein cholesterol in angiographically documented coronary artery disease

High levels of cardiac risk factors tend to cluster together and act synergistically. To develop a suitable and practical marker for clustering, we evaluated 380 consecutive patients at the time of coronary angiography. Analyses of lipid, rheologic, clinical and arteriographic profiles indicated a variety of interwoven relations. Because the ratio of total cholesterol to high-density lipoprotein (HDL) cholesterol (total/HDL cholesterol) was closely related to both the presence and extent of greater than or equal to 50% diameter reduction of greater than or equal to 1 coronary arteries, it was used to divide patients into quartiles. Clustering of high- and low-level risk factors was demonstrated in the highest and lowest quartiles of total/HDL cholesterol, respectively (p less than 0.001). The highest quartile may be characterized by an only moderately elevated total cholesterol level but patients in this quartile may have a very low HDL cholesterol level, high triglycerides, a tendency toward high hemoglobin and fibrinogen levels, a history of smoking, previous myocardial infarction and multivessel disease. These results suggest that total/HDL cholesterol serves as a marker not only for obstructive coronary disease but also for a cluster of potentially modifiable risk factors.     

Relationship between total cholesterol/high-density lipoprotein cholesterol ratio, triglyceride/high-density lipoprotein cholesterol ratio, and high-density lipoprotein subclasses

Alterations in plasma lipid levels can influence the composition, content, and distribution of plasma lipoprotein subclasses that affect atherosclerosis risk. This study evaluated the relationship between plasma total cholesterol (TC)/high-density lipoprotein cholesterol (HDL-C) ratio, triglyceride (TG)/HDL-C ratio, and HDL subclass distribution. The apolipoprotein A-I contents of plasma HDL subclasses were quantitated by 2-dimensional gel electrophoresis coupled with immunodetection in 442 Chinese subjects. The particle size of HDL shifted toward smaller size with the elevation of TC/HDL-C and TG/HDL-C ratios. The ratio of large-sized HDL(2b) to small-sized prebeta(1)-HDL (HDL(2b)/prebeta(1)-HDL) was about 4.7 in the subjects with TC/HDL-C of 3.3 or lower and TG/HDL-C of 2.5 or lower, whereas it was only approximately 1.1 in subjects with TC/HDL-C greater than 6 and TG/HDL-C greater than 5. Pearson correlation analysis revealed that the TC/HDL-C ratio was positively correlated with prebeta(1)-HDL and HDL(3a) but negatively correlated with HDL(2a) and HDL(2b), whereas the TC/HDL-C ratio was only inversely correlated with HDL(2b). The TC/HDL-C and TG/HDL-C ratios together may be a good indicator of HDL subclass distribution. When these 2 ratios increased simultaneously, the trend toward smaller HDL size was obvious, which, in turn, indicated that the maturation of HDL might be impeded and the reverse cholesterol transport might be weakened. In addition, the TG/HDL-C ratio might be a more powerful factor to influence the distribution of HDL subclasses.     

Effect of low-dose niacin on high-density lipoprotein cholesterol and total cholesterol/high-density lipoprotein cholesterol ratio

Niacin significantly alters blood lipid concentrations but its use has been limited because of clinically disturbing side effects. In an attempt to circumvent these drawbacks, 55 patients with cardiovascular disease were given low-dose long-acting niacin, 1 g/d. Treatment was continued for a mean of 6.7 months and lipid values were compared with a non-treated group of 17 patients followed for a mean of 6.3 months. Lipid values did not change in the nontreated group. In the niacin-treated group total cholesterol and triglyceride levels also did not significantly change. High-density lipoprotein (HDL) cholesterol level rose 31% from 1.01 +/- 0.31 mmol/L to 1.32 +/- 0.31 mmol/L and total cholesterol/HDL cholesterol ratio was reduced 27% from 6.4 +/- 1.9 to 4.7 +/- 1.3. Despite these results, 40% of the patients left the study mainly because of side effects. Apart from one patient who developed overt diabetes, of questionable relationship to niacin, no patient developed serious side effects such as jaundice or peptic ulcer as seen with much higher doses of the drug. Although often difficult to administer to patients, niacin, particularly in low dose, deserves consideration as an inexpensive agent especially useful for elevating HDL cholesterol level and altering the total cholesterol/HDL cholesterol ratio.     

High-density lipoprotein cholesterol and angiographic coronary artery disease in black patients

The clinical epidemiology of coronary artery disease (CAD) among black patients has not been well described, particularly in relation to the impact of the major risk factors. Lipoprotein profiles and other risk factors were measured in 114 black patients undergoing cardiac catheterization for probable CAD. Patients (coronary narrowing of 50% or greater; n = 63) were compared to those without significant stenoses (n = 51). Total cholesterol and low-density lipoprotein cholesterol (LDLC) were both significantly associated with the presence of CAD in men and women; however, high-density lipoprotein cholesterol (HDLC) had discriminatory value only for women. The ratio of total cholesterol to HDLC (TC:HDL) separated patients from control subjects in both sexes, most efficiently among women, and was the only lipid variable associated with CAD in the age group over 55 years. Hypertension and angina were frequent in both groups and did not identify those with disease. In summary, LDLC was the best predictor among the lipids for men (likelihood ratio = 9.4) and TC:HDL was the best indicator of disease among women (likelihood ratio = 15.7). Low HDLC levels may, in part, account for the increased incidence of CAD among black women. Further population studies of factors leading to reduced HDLC, namely, obesity and diabetes, are needed.     

Predictors of 14-year changes in the total cholesterol to high-density lipoprotein cholesterol ratio in men

Background

Although the ratio of total to high-density lipoprotein cholesterol (TC/HDL) is a powerful predictor of cardiovascular disease (CVD), few studies have investigated which factors are associated with changes in this ratio over time. We examined predictors of a change in TC/HDL ratio over a period of 14 years among 4451 men free of CVD from the Physicians' Health Study.

Methods

Baseline and updated physician characteristics and CVD risk factors were included in multivariate linear and logistic regression models to determine factors associated with a change in the TC/HDL ratio or of having a ratio of ≥5 on follow-up.

Results

After a mean follow-up of 14 years, mean total cholesterol decreased by 7 mg/dL, HDL increased by 1 mg/dL, and the ratio decreased by 0.37. In multivariate logistic analyses, physicians were more likely to have a TC/HDL ratio of ≥5 at follow-up if they maintained a weight of ≥25 kg/m² (OR, 1.69 [1.35 - 2.12]), gained weight (OR, 2.01 [1.55 - 2.62]), or became inactive (OR, 1.43 [1.11 - 1.83]). However, older physicians and those who consumed alcohol or received treatment for hyperlipidemia were more likely to have a ratio of <5.

Conclusions

Although pharmacologic treatment for hyperlipidemia had the greatest favorable impact on the ratio over time, our data also show that maintaining an ideal weight and exercise have beneficial effects. We therefore advocate a renewed fervor for raising public awareness of the benefits of healthy lifestyle behaviors and pharmacologic treatments that are associated with long-term maintenance of favorable cholesterol levels.     

Different clinical and coronary angiographic findings according to ratios of total cholesterol to high-density lipoprotein cholesterol during the acute phase of myocardial infarction

OBJECTIVES: Several pathological studies have shown that a higher ratio of the serum total cholesterol concentration to the high-density lipoprotein cholesterol concentration (TC/HDL-C ratio) is associated with plaque rupture in patients with acute coronary syndromes. We examined the relationship between the serum total cholesterol concentration and the TC/HDL-C ratio, and clinical and angiographic findings in patients with first acute myocardial infarction. METHODS: Two hundred eighty patients were classified into quartiles according to the TC/HDL-C ratio measured within 24 hr from symptom onset: 70 patients in the first quartile (group L: mean TC/HDL-C ratio, 3.0), 140 in the second and third quartiles (group M: mean TC/HDL-C ratio, 4.6), and 70 in the fourth quartile (group H: mean TC/HDL-C ratio, 7.5). RESULTS: There were no differences among the three groups with regard to sex, diabetes mellitus or hypertension. Patients in group L were older (66 +/- 9 vs 60 +/- 11, 56 +/- 10 years, p < 0.01) and had a higher incidence of stable angina before acute myocardial infarction (26% vs 14%, 10%, p < 0.05) than in patients groups M and H. Although coronary angiograms revealed no difference in the number of diseased vessels among the three groups, extent index indicating the proportion of each coronary segment that appears angiographically abnormal was lowest in group L (0.7 +/- 0.5), followed by group M (1.3 +/- 0.6), and high- est in group H ( 1.7 +/- 0.6, p < 0.01). The number of segments with calcification and the incidence of calcification in the culprit lesion were higher in group L than in groups M and H. CONCLUSIONS: Our findings suggest that the clinical presentations and angiographic appearances differ according to the TC/HDL-C ratio in the acute phase of acute myocardial infarction.     

Risk factors for coronary artery disease in patients with elevated high-density lipoprotein cholesterol

High high-density lipoprotein (HDL) levels protect against coronary artery disease (CAD) development. We hypothesized that patients with CAD and high HDL levels would have higher prevalence of other CAD risk factors compared with patients with CAD and normal HDL. We identified 41,982 patients from a single center with normal levels (40 to 60 mg/dl in men, 50 to 70 mg/dl in women) or high HDL levels (> or =70 mg/dl in men, > or =80 mg/dl in women) when last measured between January 2000 and April 2004. From this overall population, we characterized a cohort of 1,610 patients with CAD, including 98 patients with high HDL levels. We measured prevalence of traditional CAD risk factors by comparing these 98 patients with patients with CAD and normal HDL levels (n = 1,512). We performed manual chart review in patients (n = 196) matched 1:1 by age, gender, and HDL level to obtain further detail with regard to differences in family history and lifestyle factors. In patients with CAD, those with high HDL levels (98 of 1,610, 6.1%) were of similar age (71.1 vs 69.6 years, p = 0.23), had similar prevalence of hypertension (78.6% vs 88.7%, p = 0.30), lower levels of low-density lipoprotein (85.3 vs 90.9 mg/dl, p = 0.04) and triglycerides (87.1 vs 141.2 mg/dl, p <0.01), and a lower prevalence of diabetes (28.6% vs 38.4%, p = 0.05) compared with patients with normal HDL levels. In logistic regression models, patients with high HDL levels and CAD were less likely to have diabetes (adjusted odds ratio 0.60, 95% confidence interval 0.38 to 0.95, p = 0.03) or obesity (adjusted odds ratio 0.50, 95% confidence interval 0.25 to 0.99, p = 0.046) than patients with normal HDL levels and CAD. In conclusion, patients with high HDL and CAD had a similar or lower prevalence of traditional CAD risk factors compared with patients with normal HDL levels and CAD.     

Relation of serum lipoprotein cholesterol levels to presence and severity of angiographic coronary artery disease.

To assess the relation of lipid levels to angiographic coronary artery disease (CAD), lipid profiles were obtained on 125 men and 72 women undergoing diagnostic coronary angiography. CAD, defined as greater than or equal to 25% diameter narrowing in a major coronary artery, was present in 106 men (85%) and 54 women (75%). Multiple regression analyses revealed that only high-density lipoprotein (HDL) cholesterol level in men, and age and total/HDL cholesterol ratio in women, were independently associated with the presence of CAD after adjustment for other risk factors. HDL cholesterol level and age were significantly correlated with both extent (number of diseased vessels) and severity (percent maximum stenosis) of CAD in men. In women, age was the only independent variable related to severity, whereas age and total/HDL cholesterol ratio were related to extent. Of 71 patients with total cholesterol less than 200 mg/dl, 79% had CAD. With multiple regression analyses, HDL cholesterol was the only variable independently related to the presence and severity of CAD in these patients after adjustment for age and gender; extent was significantly associated with age and male gender, and was unrelated to any of the lipid parameters. With use of multiple logistic and linear regression analyses of the group of 197 patients, HDL cholesterol was the most powerful independent variable associated with the presence and severity of CAD after adjustment for age and gender. HDL cholesterol was also an independent predictor of extent. Age was independently associated with each of the end points examined, and was the variable most significantly related to extent. These data add to the growing body of information demonstrating an important association between HDL and CAD.     

血清总胆固醇与高密度脂蛋白胆固醇水平对患者心力衰竭结局的影响

目的:通过对我院临床资料进行随访回顾性研究,以评估TC和HDL-C水平与冠心病心力衰竭患者预后的相关性,以期指导临床的治疗。方法:选择2013年1月至2015年12月,我院收治冠心病且伴有心力衰竭的住院患者231例,年龄37~79岁,平均年龄(63.7±14.8)岁。记录患者年龄,性别,血压,身高体质量,吸烟饮酒状况,家族冠心病史,病史(高血压,心肌梗死,糖尿病等),血脂,肝功能,超声心动图等检查指标。对患者出院后进行随访,平均随访时间为18(12~24)个月。结果:231例患者中,总共完成随访208例,余23例患者失访,随访成功率90%。加重组患者的吸烟率,饮酒率,家族冠心病发病率显著高于缓解组(P<0.05),而加重组患者的TC和HDL-C水平显著低于缓解组患者(P<0.05)。多因素Logistic回归分析结果显示低水平的TC(OR=0.831,95%CI:0.737~0.912,P=0.002)和低水平的HDL-C(OR=0.815,95%CI:0.697~0.933,P=0.013)是冠心病心力衰竭预后不良的独立危险因素,吸烟,饮酒和冠心病家族史对预后无明显影响。结论:TC和HDL-C水平与冠心病患者心力衰竭预后相关,患者TC和HDL-C水平越低,其预后结局可能越差。     

绝经后女性单核细胞/高密度脂蛋白胆固醇与冠状动脉SYNTAX评分的关系

目的探讨绝经后女性单核细胞/高密度脂蛋白胆固醇比值(MHR)与冠状动脉SYNTAX评分的相关性。方法入组接受冠状动脉造影术确诊为冠状动脉粥样硬化性心脏病(冠心病)的绝经后女性180例,根据MHR(以第33和第66百分位点为截点)分为三组:低MHR组:MHR0.28(n=59);中MHR组:0.28≤MHR≤0.43(n=61);高MHR组:MHR0.43(n=60)。比较三组SYNTAX评分差异,采用Spearman相关性分析和多重线性回归分析MHR与SYNTAX评分的关系。结果高MHR组的SYNTAX评分(25±13)高于低MHR组(18±13)和中MHR组(19±12)(P=0.003)。高MHR组的白细胞计数、中性粒细胞计数、血清C反应蛋白水平均高于低MHR组和中MHR组(P0.001)。Spearman相关分析表明MHR与SYNTAX评分相关(r=0.263,P0.001)。多因素线性回归分析结果提示SYNTAX评分受MHR的影响,冠状动脉病变严重程度与MHR密切相关(F=4.777,P=0.031)。结论绝经后女性冠心病患者MHR与冠状动脉SYNTAX评分呈正相关,可预测冠状动脉病变的严重程度。     

LDL-C/HDL-C比值对经皮冠脉介入术后患者心血管事件的预测价值

目的 评估低密度脂蛋白胆固醇(LDL-C)/高密度脂蛋白胆固醇(HDL-C)比值对经皮冠脉介入(PCI)术后患者心血管事件的预测价值.方法 选择急性冠脉综合征(ACS)并予前降支置入支架的患者119例,依据血浆LDL-C/HDL-C比值将患者分为3组,随访1年,评估三组患者心血管事件发生率,以及各危险因素与心血管事件发生率的关系.结果 ①与LDL-C/HDL-C比值较低的两组相比,比值较高组患者体重指数、女性患者百分率、吸烟人数及糖化血红蛋白、高敏C反应蛋(hs-CRP)、总胆固醇和LDL-C水平均明显升高,而HDL-C水平和他汀类药物使用率则较低(P＜0.05).②第1组风险比(HR)1.04,95％可信区间(CI)0.98～1.08,第2组HR 1.16,95％CI 1.08～1.20,第3组HR 1.27,95％CI 1.19～1.36(P＜0.05).随着LDL-C/HDL-C比值的升高,PCI术后1年患者心血管事件发生率也逐渐升高(P＜0.05).③Cox比例风险回归模型提示,LDL-C/HDL-C比值对PCI术后心血管事件风险的预测价值优于其他危险因素.结论 LDL-C/HDL-C比值对PCI术后患者1年内心血管事件再发具有一定的预测价值.     

Use of the plasma triglyceride/high-density lipoprotein cholesterol ratio to identify cardiovascular disease in hypertensive subjects

This analysis evaluated the hypothesis that the plasma triglyceride (TG)/high–density lipoprotein cholesterol (HDL-C) concentration ratio can help identify patients with essential hypertension who are insulin–resistant, with the cardiovascular disease (CVD) risk profile associated with that defect. Data from a community–based study developed between 2003 and 2012 were used to compare CVD risk factors and outcome. Plasma TG/HDL-C cut–points of 2.5 (women) and 3.5 (men) subdivided normotensive (n = 574) and hypertensive (n = 373) subjects into “high” and “low” risk groups. Metabolic syndrome criteria (MetS) were also used to identify “high” and “low” risk groups. The baseline cardio–metabolic profile was significantly more adverse in 2003 in “high” risk subgroups, irrespective of BP classification or definition of risk (TG/HDL-C ratio vs. MetS criteria). Crude incidence of combined CVD events increased across risk groups, ranging from 1.9 in normotensive–low TG/HDL-C subjects to 19.9 in hypertensive–high TG/HDL-C ratio individuals (P for trends <.001). Adjusted hazard ratios for CVD events also increased with both hypertension and TG/HDL-C. Comparable findings were seen when CVD outcome was predicted by MetS criteria. The TG/HDL-C concentration ratio and the MetS criteria identify to a comparable degree hypertensive subjects who are at greatest cardio–metabolic risk and develop significantly more CVD.     

Low-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio as a useful marker for early-stage carotid atherosclerosis

A higher ratio of low-density lipoprotein cholesterol (LDL-C) to high-density lipoprotein cholesterol (HDL-C) is associated with a greater risk of cardiovascular events in patients with coronary heart disease. However, the role of this lipid index during early-stage atherosclerosis has not yet been established. This study investigated relationships between LDL-C/HDL-C ratio and carotid plaque score as assessed by ultrasonography in 825 subjects from the general population (527 men, 298 women; mean age, 60.5 years). To identify factors strongly associated with plaque score, stepwise multiple regression analysis was performed using various clinical variables including conventional lipid indices. In both sexes, increased LDL-C/HDL-C ratio was associated with increased plaque score (men: β = 0.132, P = .001; women: β = 0.150, P = .012). This association was maintained in men with normal LDL-C level (<140 mg/dL). The highest quartile of LDL-C/HDL-C ratio (>2.9 in men, >2.6 in women) showed significantly increased plaque score even when adjusted by factors included in the final model of stepwise analysis (P = .007 in men, P = .033 in women). No association was seen between LDL-C and plaque score in the multivariate-adjusted model. These findings indicate that increased LDL-C/HDL-C ratio may also be associated with initiation of atherosclerosis. Assessment of this lipid ratio may thus facilitate early management of atherosclerotic risks better rather than assessment of LDL-C alone.     

A risk biomarker for obstructive sleep apnea in patients with coronary artery disease: monocyte to high-density lipoprotein ratio

Sleep and Breathing - The monocyte to high-density lipoprotein ratio (MHR) has been postulated to be a novel indicator associated with adverse cardiovascular outcomes in patients with coronary...     

Efficacy of raising high-density lipoprotein cholesterol for prevention of coronary heart disease

Conclusions Treatment decisions related to disease prevention are often based on related assumptions. An intervention-induced change in a surrogate marker (such as HDL cholesterol) in the desired direction translates into health benefits (such as reduction in coronary events). The VA-HIT showed that fibric acid therapy significantly reduced major cardiovascular events (cardiovascular death, myocardial infarction, and stroke) in patients with CHD by raising HDL cholesterol. However, the efficacy of the treatment may be also explained by lowering triglycerides. A low HDL cholesterol concentration and hypertriglyceridemia are frequently accompanied by the features of the metabolic syndrome found in impaired glucose tolerance and in individuals who are abdominally obese. New National Cholesterol Education Program Adult Treatment III guidelines emphasize the importance of metabolic syndrome and raise the cutoff level for defining abnormally low HDL, incorporate triglyceride levels into treatment strategies when they exceed 200 mg/dL, and recognize that in some patient populations treatment specifically designed to increase HDL levels is appropriate. In metabolic syndromes, highly atherogenic lipoproteins, such as remnant lipoproteins and small dense LDL, are also increased. Thus, treatment should focus on not only raising HDL cholesterol and lowering triglycerides, but also normalizing the total dyslipidemia, in order to raise the efficacy of the treatment for CHD prevention.