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Total Cholesterol/HDL Cholesterol Ratio vs LDL Cholesterol/HDL Cholesterol Ratio as Indices of Ischemic Heart Disease Risk in Men
The Quebec Cardiovascular Study
Isabelle Lemieux, MSc;
Benoît Lamarche, PhD;
Charles Couillard, PhD;
Agnès Pascot, MSc;
Bernard Cantin, MD, PhD;
Jean Bergeron, MD, MSc;
Gilles R. Dagenais, MD;
Jean-Pierre Després, PhD
Arch Intern Med. 2001;161:2685-2692.
Background Total cholesterol (TC)/high-density lipoprotein cholesterol (HDL-C)
and low-density lipoprotein cholesterol (LDL-C)/HDL-C ratios are used to predict
ischemic heart disease risk. There is, however, no consensus on which of these
2 indices is superior. The objective of the present study was to present evidence
that the LDL-C/HDL-C ratio may underestimate ischemic heart disease risk in
overweight hyperinsulinemic patients with high triglyceride (TG)–low
HDL-C dyslipidemia.
Methods A total of 2103 middle-aged men in whom measurements of the metabolic
profile were performed in the fasting state were recruited from 7 suburbs
of the Quebec metropolitan area.
Results The relationship of LDL-C/HDL-C to TC/HDL-C ratios was examined among
men in the Quebec Cardiovascular Study classified into tertiles of fasting
TG levels. For any given LDL-C/HDL-C ratio, the TC/HDL-C ratio was higher
among men in the top TG tertile (>168 mg/dL [>1.9 mmol/L]) than in men in
the first and second TG tertiles. Adjustment of the TC/HDL-C ratio for LDL-C/HDL-C
by covariance analysis generated significant differences in average TC/HDL-C
ratios among TG tertiles (P<.001). Greater differences
in features of the insulin resistance syndrome (insulinemia, apolipoprotein
B, and LDL size) were noted across tertiles of the TC/HDL-C ratio than tertiles
of the LDL-C/HDL-C ratio.
Conclusion Variation in the TC/HDL-C ratio may be associated with more substantial
alterations in metabolic indices predictive of ischemic heart disease risk
and related to the insulin resistance syndrome than variation in the LDL-C/HDL-C
ratio.
From the Quebec Heart Institute, Laval Hospital Research Center Mss
Lemieux and Pascot and Drs Couillard, Cantin, Dagenais, Després), and
the Lipid Research Center, CHUL Research Center (CHUQ) (Drs Lamarche, Couillard,
Cantin, Bergeron, and Després and Mss Lemieux and Pascot), Sainte-Foy,
Quebec.
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