title: Cholesterol measures to identify and treat individuals at risk for coronary heart disease.
abstract: BACKGROUND
  Low-density lipoprotein (LDL)-based guidelines are currently used to initiate and monitor cholesterol-lowering therapy.
  
  
  METHODS
  Using stratified analyses, data from the Framingham Heart Study and the Coronary Primary Prevention Trial were evaluated to determine whether (1) cholesterol levels (total cholesterol [TC] or LDL [low-density lipoprotein]) better discriminated risk for coronary heart disease (CHD) than cholesterol ratios (LDL/HDL [high-density lipoprotein] or TC/HDL); and (2) whether changes in ratios better predicted risk reduction than changes in levels.
  
  
  RESULTS
  Individuals with similar LDL/HDL ratios had similar risks for CHD regardless of whether they had high LDL levels or low LDL levels (23% vs 23% for the CPPT, 13.8% vs 14% for FHS men, and 8.6% vs 10.9% for FHS women). Among men with similar initial LDL/HDL ratios and similar changes in LDL/HDL ratios, risks for CHD did not differ (20.3% compared with 21.0%; p =0.96) between those with the largest and smallest reductions in LDL levels (21.3% compared with 6.5%). Among men with similar initial LDL levels and similar LDL reductions, a 20% reduction in risk for CHD was seen (19.5% compared with 24.5%; p =0.005) between those with the largest and smallest reductions in LDL/HDL ratios (23% compared with 4.6%). TC/HDL had predictive ability similar to LDL/HDL.
  
  
  CONCLUSIONS
  Cholesterol levels do not provide incremental predictive value over cholesterol ratios in identifying people at risk for CHD. Changes in ratios are better predictors of successful CHD risk reduction than changes in levels. Future guidelines should consider incorporating ratios in initiating and monitoring successful lipid-lowering therapy.
authors.affiliation: Department of Medicine, VA New York Harbor Healthcare System (Natarajan), New York, New York 10010, USA. sundar.natarajan@med.nyu.edu
authors.forename: Sundar
authors.initials: S
authors.lastname: Natarajan
authors.forename: Henry
authors.initials: H
authors.lastname: Glick
authors.forename: Michael
authors.initials: M
authors.lastname: Criqui
authors.forename: David
authors.initials: D
authors.lastname: Horowitz
authors.forename: Stuart R
authors.initials: SR
authors.lastname: Lipsitz
authors.forename: Bruce
authors.initials: B
authors.lastname: Kinosian
mesh_terms: D008076:Cholesterol, HDL / Q000097:blood*; D008078:Cholesterol, LDL / Q000097:blood*; D003327:Coronary Disease / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D010919:Placebos; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D014481:United States
chemical_list: D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D010919:Placebos