Usefulness of total cholesterol/HDL-cholesterol ratio in the management of diabetic dyslipidaemia.
OBJECTIVE
Our aim was to evaluate the usefulness of the total cholesterol/HDL-cholesterol ratio (TC/HDL) in predicting the cardiovascular risk of Type 2 diabetic patients.


METHODS
Prospective cohort study with inclusion of 418 Type 2 diabetic individuals with follow-up until the appearance of a cardiovascular event. The predictive power of updated mean lipid values during follow-up was analysed by means of Cox proportional hazard models. An estimate was made of the relative risk (RR) conferred by high levels of TC/HDL stratified by LDL-cholesterol levels.


RESULTS
Sixty-six cardiovascular events occurred during an average follow-up of 4.7 years (sd 1.5). The main lipid predictor of vascular events was mean TC/HDL ratio [hazard ratio (HR) = 1.46; 95% confidence interval (CI) 1.25, 1.7; P < 0.0001]. In the multivariate model with simultaneous inclusion of mean TC/HDL and mean LDL-cholesterol, both were significant predictors of cardiovascular disease [HR (1 unit) = 1.37; 95% CI 1.16, 1.62; P = 0.0003 and HR (1 mmol/l) = 1.5; 95% CI 1.04, 2.18; P = 0.03, respectively]. The LDL adjusted RR for cardiovascular events due to high TC/HDL ratio, with 4.5 cut-off point, was 2.5 (95% CI 1.4, 4.3; P = 0.0007). For the stratum of subjects with average LDL cholesterol < 3.5 mmol/l, RR was 1.2 (95% CI 0.5, 2.8; P = NS) and for the stratum of average LDL cholesterol > 3.5 mmol/l, RR was 4 (95% CI 1.8, 9; P = 0.00013), with heterogeneity among strata (P = 0.044).


CONCLUSIONS
It could be useful to include the TC/HDL ratio in treatment guides for diabetic dyslipidaemia, given their high predictive value and strong interaction with LDL cholesterol.
Gimeno-Orna
J A
JA
Department of Endocrinology, Alcañiz Hospital, Teruel, Spain. mjpnosti@eresmas.com
Faure-Nogueras
E
E
Sancho-Serrano
M A
MA
D002784:Cholesterol / Q000097:blood*; D008076:Cholesterol, HDL / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood*; D003925:Diabetic Angiopathies / Q000097:blood*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000097:blood*; D008297:Male; D008875:Middle Aged
D008076:Cholesterol, HDL; D002784:Cholesterol