Circulation, Vol 67, 730-734, Copyright © 1983 by American Heart Association
WP Castelli, RD Abbott and PM McNamara
The relationships of total cholesterol and the proportion of cholesterol in
individual lipoprotein classes to coronary heart disease are complex. To
help simplify these relationships, cholesterol values are often combined
into one summary estimate to form a single risk factor with a relationship
to disease that is more easily described. Although summary estimates result
in convenient expressions relating cholesterols to coronary heart disease,
there is the potential for sacrificing information by ignoring the joint
configuration of cholesterols that make up these estimates. We investigated
the extent of this possibility for the ratio of total cholesterol to
high-density lipoprotein cholesterol and the ratio of low-density
lipoprotein cholesterol to high-density lipoprotein cholesterol. The
findings suggest that the summary estimates are useful expressions for
combining cholesterol information and are strong predictors of coronary
heart disease. Clinicians who choose to use a summary estimate for
screening purposes should recognize that a single ratio estimate is not
always as informative as the joint configuration of the cholesterols that
make up the estimate. This possibility is most clearly exhibited for the
ratio of low-density lipoprotein cholesterol to high-density lipoprotein
cholesterol, and it may become more apparent in future studies as the
capabilities of exploring lipoprotein cholesterol relationships improve.
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Summary estimates of cholesterol used to predict coronary heart disease
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