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TOTAL CHOLESTEROL:HDL RATIO IS VALIDATED AS A POWERFUL MI PREDICTOR.

Levels of a number of lipoproteins and apolipoproteins have been found to predict the risk of myocardial infarction, but few large studies have used multivariate techniques to evaluate each marker independently of the others.

As part of the prospective Physicians' Health Study, over 14,000 men had blood samples collected. After five years of follow-up, 246 men who had suffered an MI were matched by age and smoking status with 246 control subjects without MI. Researchers then examined the independent predictive power of various lipoproteins, apolipoproteins, and ratios of these potential predictors.

The ratio of total cholesterol to HDL was a powerful predictor: after adjusting for other risk factors, men with a total cholesterol level above the median and HDL below the median had a 3.8 times greater risk of MI than men with a total cholesterol level below the median and HDL above the median. The apolipoproteins and the HDL subfractions had little independent predictive power in the multivariate analysis once the total cholesterol:HDL ratio was considered. The study did not measure LDL or triglycerides.

This large and careful study validates the utility of an easily available and commonly used measure of cardiac risk: the total cholesterol:HDL ratio. The authors conclude that the measurement of HDL should be used more widely.

— ALK

Published in Journal Watch General Medicine August 13, 1991

Citation(s):

Stampfer MJ et al. A prospective study of cholesterol, apolipoproteins, and the risk of myocardial infarction. N Engl J Med 1991 Aug 8 325 373-381.

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