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LDL:HDL cholesterol ratio is marker of early atherosclerosis

By Jeremy Cockerill | November 18, 2009

By Joanna Lyford

The ratio of low-density to high-density lipoprotein cholesterol (LDL-C:HDL-C) is associated with the burden of carotid plaque and may thus serve as a marker of early atherosclerosis, Japanese researchers believe.

Their conclusion is based on a study involving 825 consecutive healthy men and women from the general population, with a mean age of 60.5 years. As part of an annual health check-up, all participants underwent physical examination, medical history, and carotid ultrasound.

A “plaque score” was calculated for each patient, defined as the sum of maximum heights of each plaque located in the extracranial portion of both carotid arteries. The mean plaque score was 1.1 mm in men and 0.4 mm in women.

Makido Tamada (Iwate Medical University, Morioka) and co-workers then used stepwise multiple regression analysis to identify variables associated with plaque score.

In both men and women, an increased LDL-C:HDL-C ratio was significantly and independently associated with increased plaque score; individuals in the highest quartile of the ratio (>2.9 in men, >2.6 in women) had significantly greater plaque scores than those in the lowest quartile (1.45 vs 0.93 for men, 0.71 vs 0.40 for women), an effect that was significant even after adjusting for multiple confounding variables.

This association remained significant in men with normal levels of serum LDL-C (<140 mg/dl [3.62 mmol/l]), although not in normolipidemic women.

Writing in the journal Metabolism Clinical and Experimental, Tamada et al say that the LDL-C:HDL-C ratio “represents an independent lipid index to reflect early-stage carotid atherosclerosis in apparently healthy men and women from the general population.”

Further, they suggest that the ratio “may also be associated with the initiation of atherosclerosis” through the influence of circulating LDL-C and HDL-C concentrations on lipid accumulation in the arterial wall and the severity of atherosclerotic intimal changes.

However they admit that the present data cannot be used to support targeting the LDL-C:HDL-C ratio as a primary preventive strategy in early-stage atherosclerosis.