Low-Density Lipoprotein-Cholesterol/High-Density Lipoprotein-Cholesterol Ratio Predicts Lipid-Rich Coronary Plaque in Patients With Coronary Artery Disease - Integrated-Backscatter Intravascular Ultrasound Study -

Abstract

Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp igh serum levels of low-density lipoprotein-cholesterol (LDL-C) are a major risk factor for atherosclerotic cardiovascular disease. 1 Controlled lowering of LDL-C levels is important for primary and secondary prevention of coronary artery disease (CAD). 2,3 A previous study showed a significant reduction in coronary plaque volume at blood LDL-C levels <100 mg/dl after statin therapy. 4,5 The Framingham study demonstrated that higher LDL-C was a higher relative risk predictor for coronary events. Furthermore, a subgroup analysis of LDL-C and high-density lipoprotein-cholesterol (HDL-C) levels showed that the ratio was a more precise predictor for the relative risk of cardiac events. 6 Another recent study has shown that the predictive value for a cardiovascular event using LDL-C/HDL-C (L/H) ratio is equivalent to the apolipoprotein (Apo) B/ApoA-1 ratio, a precise marker of lipid metabolism. 7 Moreover, posthoc subanalysis of the Treating to New Targets trial, which investigated the correlation between lipid profile and cardiovascular events after statin use for 3 months, showed that the risk of cardiovascular events was increased as the L/H ratio increased, indicating that this ratio is a strong predictor for cardiovascular events. 8 A recent meta-analysis using intravascular ultrasound (IVUS) for evaluating coronary plaque has demonstrated that an L/H ratio >2.0 was associated with progression, while an L/H ratio ≤2.0 was associated with regression of plaque volume. 9

Is Low-Density Lipoprotein/High-Density Lipoprotein (LDL/HDL)-Cholesterol Ratio a More Important Predictor of Vulnerable Plaque in Coronary Artery Disease Than LDL- or HDL-Cholesterol?

“…3 This finding indicates that LDL/HDL-cholesterol ratio might be a more important risk factor than LDL-cholesterol itself in CAD patients, and should be investigated further. …”

“…3 They studied not only plaque volume but also the lipid pool area of atherosclerotic coronary arteries in chronic coronary artery disease (CCAD) and acute coronary syndrome (ACS) using integrated backscatter (IB) intravascular ultrasound (IVUS).…”

Elevated Small Dense Low-Density Lipoprotein Cholesterol as a Predictor for Future Cardiovascular Events in Patients with Stable Coronary Artery Disease

“…A recent large Danish cohort study investigating genotypes and nonfasting lipid levels for CAD risk demonstrated that a 1 mmol/L (39 mg/dL) increase in non-fasting RLP-C calculated as non-fasting total-cholesterol minus HDL-C minus LDL-C, was associated with a 2.8-fold increased causal risk for CAD, independent of reduced HDL-C level, whereas as 1 mmol/L increase in LDL-C was only associated with a 1.5-fold causal risk 49) . In addition, recent studies have shown that the LDL-C/ HDL-C ratio might be a positive predictor of progression and lipid-rich coronary plaque, which results in unstable coronary atherosclerotic lesion 15,50) . The Koba by Gensini score, elevated levels of BNP indicating advanced heart failure, the presence of diabetes and/or elevated HbA1c, decreases in eGFR, inflammation reflected by CRP levels, and advanced age were stronger predictors for cardiovascular events than lipid markers.…”

Atherogenic lipids profile relates to postprandial hyperglycemia and hyperinsulinemia due to whole body insulin resistance in prediabetic subjects

“…In addition, TG to HDL ratio (TG/HDL) has been shown to indicate the presence of sdLDL particles and could serve as a good predictor of coronary heart disease (CHD) [15,16]. LDL to HDL ratio (LDL/HDL) was also found to predict CHD as do total cholesterol (TC) to HDL ratio (TC/HDL) and ApoB/ApoA-1 ratio [17,18]. However, effects of different types of glucose intolerance on non-HDL, TG/HDL and LDL/HDL are unclear.…”