title: Is High Serum LDL/HDL Cholesterol Ratio an Emerging Risk Factor for Sudden Cardiac Death? Findings from the KIHD Study.
abstract: OBJECTIVE
  Low-density lipoprotein cholesterol (LDL-c) and high-density lipoprotein cholesterol (HDL-c), which are components of total cholesterol, have each been suggested to be linked to the risk of sudden cardiac death (SCD). However, the relationship between LDL-c/HDL-c ratio and the risk of SCD has not been previously investigated. We aimed to assess the associations of LDL-c, HDL-c, and the ratio of LDL-c/HDL-c with the risk of SCD.
  
  
  METHODS
  Serum lipoprotein concentrations were assessed at baseline in the Finnish Kuopio Ischemic Heart Disease prospective cohort study of 2,616 men aged 42-61 years at recruitment. Hazard ratios (HRs) (95% confidence intervals [CI]) were assessed.
  
  
  RESULTS
  During a median follow-up of 23.0 years, a total of 228 SCDs occurred. There was no significant evidence of an association of LDL-c or HDL-c with the risk of SCD. In analyses adjusted for age, examination year, body mass index, systolic blood pressure, smoking, alcohol consumption, physical activity, years of education, diabetes, previous myocardial infarction, family history of coronary heart disease, and serum high sensitivity C-reactive protein, there was approximately a two-fold increase in the risk of SCD (HR 1.94, 95% CI 1.21-3.11; p=0.006), comparing the top (＞4.22) versus bottom (≤2.30) quintile of serum LDL-c/HDL-c ratio.
  
  
  CONCLUSIONS
  In this middle-aged male population, LDL-c or HDL-c was not associated with the risk of SCD. However, a high serum LDL-c/HDL-c ratio was found to be independently associated with an increased risk of SCD. Further research is warranted to understand the mechanistic pathways underlying this association.
authors: School of Clinical Sciences, University of Bristol, Learning & Research Building (Level 1), Southmead Hospital.
authors: Setor K
authors: SK
authors: Kunutsor
authors: Diabetes Research Centre, University of Leicester.
authors: Francesco
authors: F
authors: Zaccardi
authors: Institute of Public Health and Clinical Nutrition, University of Eastern Finland.
authors: Jouni
authors: J
authors: Karppi
authors: Institute of Public Health and Clinical Nutrition, University of Eastern Finland.
authors: Sudhir
authors: S
authors: Kurl
authors: Institute of Public Health and Clinical Nutrition, University of Eastern Finland.|Department of Medicine, Central Finland Central Hospital.
authors: Jari A
authors: JA
authors: Laukkanen
mesh_terms: D000328:Adult; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000032:analysis; D008076:Cholesterol, HDL / Q000097:blood*; D008078:Cholesterol, LDL / Q000097:blood*; D003327:Coronary Disease / Q000097:blood; D016757:Death, Sudden, Cardiac; D005500:Follow-Up Studies; D006801:Humans; D008074:Lipoproteins / Q000097:blood; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood; D017202:Myocardial Ischemia / Q000097:blood*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012424:Rural Population; D014505:Urban Population
chemical_list: D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D008074:Lipoproteins; D002097:C-Reactive Protein
keywords: High-density lipoprotein cholesterol; Low-density lipoprotein cholesterol; Sudden cardiac death