Abstract 12503: Low-Density Lipoprotein Cholesterol to High-Density Lipoprotein Cholesterol Ratio is a Useful Risk Marker for Acute Myocardial Infarction and Sudden Death in Normocholesterolemic Male Population
Background: Several epidemiological studies have demonstrated that plasma low-density lipoprotein cholesterol (LDL-C) levels are a key risk factor for coronary heart disease (CHD). However, many patients with CHD have normal LDL-C levels. Furthermore, LDL-C/high-density lipoprotein cholesterol (HDL-C) ratio has been reported to be a relevant marker for the prediction of future CHD. We investigated the predictive power of these indices by comparison with LDL-C or HDL-C according to plasma LDL-C levels.
Methods: A population-based prospective cohort study was performed in 7,931 male subjects aged ≥ 40 years (mean age = 63 years) not taking cholesterol-lowering drugs and with no cardiovascular history. A multivariate Cox regression analysis adjusted for age, BMI, systolic blood pressure, eGFR, diabetes, and smoking was performed to examine the relationship between lipid indices and incidence of acute myocardial infarction/sudden death (AMI/SD) in subjects both above and below the median LDL-C level (112 mg/dl = 2.90 mmol/L).
Results: During a mean follow-up period of 5.6 years, 80 male subjects developed AMI/SD. The hazard ratios for AMI/SD associated with a 1-standard deviation (SD) increase in LDL-C/HDL-C ratio were 1.70 (95% CI: 1.02 to 2.83) in subjects with lower LDL-C levels, and 1.34 (95% CI: 1.03 to 1.76) in subjects with higher LDL-C levels. However, there was no significant association between the 1-SD increase in LDL-C, or HDL-C levels and risk of AMI/SD incidence in subjects with lower or higher LDL-C levels (see Figure).
Conclusion: In this prospective study, regardless of the presence of normocholesterolemic subjects, higher LDL-C/HDL-C ratios were associated with an increased incidence of AMI/SD. Estimation of this lipid ratio may therefore enable identification of subjects with normal LDL-C levels who have a high risk for AMI/SD.
- © 2011 by American Heart Association, Inc.