title: Cholesterol and coronary heart disease: predicting risks by levels and ratios.
abstract: OBJECTIVE
  Comparison of four measures of cholesterol for predicting men and women who will develop coronary heart disease within 8 to 10 years.
  
  
  METHODS
  Cohort study.
  
  
  METHODS
  1898 men who received placebo (the placebo group of the Lipid Research Clinics [LRC] Coronary Primary Prevention Trial [CPPT]), 1025 men and 1442 women who participated in the 1970-1971 Framingham Heart Study biennial examination, and 1911 men and 1767 women without coronary heart disease who were from the LRC Population Prevalence Study.
  
  
  METHODS
  Total cholesterol, low-density lipoprotein (LDL) cholesterol, ratio of total cholesterol to high-density lipoprotein (HDL) cholesterol, and the ratio of LDL to HDL. Outcomes were coronary heart disease in the CPPT and Framingham studies and death from coronary heart disease in the Prevalence Study.
  
  
  RESULTS
  Independent information in the total cholesterol/HDL ratio added risk-discriminating ability to total cholesterol and LDL cholesterol measures (P < 0.02), but the reverse was not true. Among women, a high-risk threshold of 5.6 for the total cholesterol/HDL ratio identified a 0% to 15% larger group at 25% to 45% greater risk in the Prevalence and Framingham studies, respectively, than did current guidelines. Among men in the same studies, a risk threshold of 6.4 for the total cholesterol/HDL ratio identified a 69% to 95% larger group at 2% to 14% greater risk than did LDL cholesterol levels alone. Eight-year likelihood ratios for coronary heart disease ranged from 0.32 to 3.11 in men and from 0.59 to 2.98 in women for total cholesterol/HDL ratios (grouped from < 3 to > or = 9).
  
  
  CONCLUSIONS
  The total cholesterol/HDL ratio is a superior measure of risk for coronary heart disease compared with either total cholesterol or LDL cholesterol levels. Current practice guidelines could be more efficient if risk stratification was based on this ratio rather than primarily on the LDL cholesterol level.
authors.affiliation: University of Pennsylvania, Division of General Internal Medicine, Ralston-Penn Center, Philadelphia 19104.
authors.forename: B
authors.initials: B
authors.lastname: Kinosian
authors.forename: H
authors.initials: H
authors.lastname: Glick
authors.forename: G
authors.initials: G
authors.lastname: Garland
mesh_terms: D000328:Adult; D000368:Aged; D002784:Cholesterol / Q000097:blood*; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D015331:Cohort Studies; D003327:Coronary Disease / Q000097:blood*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests
chemical_list: D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D002784:Cholesterol