Friday, March 03, 2006

Lipid profiles and the Framingham study

The current cholesterol treatment guidelines have designated low-density lipoprotein (LDL) cholesterol as the major target for the treatment of dyslipidemia.

But what about HDL and total cholesterol?

This report, from the long-running Framingham study, examined the influence of the total/HDL cholesterol ratio on coronary heart disease (CHD) risk at high, medium, and low levels of total and LDL cholesterol. This tests whether the level of the components of the total/HDL cholesterol ratio need to be taken into account in assessing dyslipidemic risk and response to treatment.


  • Little difference was found in the effect of the total/HDL cholesterol and LDL/HDL ratios as predictors of the risk of CHD. It thus appears that the ratios can be used to determine CHD risk efficiently, irrespective of the LDL cholesterol level, particularly in men.
  • It appears that when the total/HDL or LDL/HDL cholesterol ratio is favorable, the level of the lipids that compose the ratio on CHD risk has little influence. This suggests that a favorable ratio justifies a conservative approach for elevated lipids (with diet, exercise, and weight control), rather than aggressive drug treatment.
  • In men, the LDL cholesterol level reflected the lowest risk factor (relative risk 1.9), and the total/HDL cholesterol ratio predicted the greatest risk (relative risk 2.9).
  • In women, LDL cholesterol imparted the highest risk of the individual lipids (relative risk 3.9), and this was not exceeded by the lipid ratio (relative risk 3.8).

The total/HDL ratio is very important for both sexes and indications are that the total/HDL and LDL/HDL ratios are more powerful predictors than the lipids from which they are comprised. The total/HDL ratio appears to predict CHD equally well at low and high total cholesterol values.

More reason to raise the HDL as modest increases cut risk significantly.

Clinical strategies to elevate HDL.


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