Cholesterol Ratio: A Far Better Predictor of Heart Disease Risk

| June 13, 2011

Cholesterol comes in two main forms in the bloodstream: ‘low density lipoprotein’ (LDL) and ‘high density lipoprotein’ (HDL) cholesterol. Conventional wisdom tells us that LDL-cholesterol is deposited on the inside of the arteries, and may lead to heart disease. For this reason, LDL-cholesterol is dubbed ‘bad’ cholesterol.

On the other hand, HDL-cholesterol, we’re told, comes from cholesterol ‘released’ from the inside of arteries. Higher levels of HDL-cholesterol are associated with lower risk of heart disease, for instance, and it’s often referred to as ‘good’ cholesterol for this reason.

Thinking this conventional wisdom through for a moment, one could argue that heart disease risk might have some link with the relative amounts of LDL- and HDL-cholesterol in the bloodstream. There used to be a vogue for assessing this by dividing the total cholesterol level by the HDL level. Generally speaking, the lower the ratio, the better. Also, having a ratio of less than 5.0 was considered desirable.

The practice of calculating ratios like this, rather than looking at absolute values, is actually supported in the scientific evidence. For example, in one study drawing on a huge amount of data, risk of heart disease and its association with cholesterol ratios and absolute cholesterol values was assessed [1]. Here are the two main findings from this research:

      1. Risk of heart disease was higher for individuals with unfavourable cholesterol ratios, irrespective of whether their LDL levels were high or low.
      2. Changes in LDL levels had relatively little relationship with risk of heart disease, compared to changes in cholesterol ratios which did.

In short, the cholesterol ratio was a much better predictor of risk of heart disease than LDL values alone. Somehow, despite this evidence, it occurs to me that concept of cholesterol ratio has gone out of vogue. I still see it calculated by some laboratories, but I rarely hear doctors or scientists in the field refer to it. Why?

Many of you will be aware there is increasing and unrelenting pressure put on people to drive their cholesterol to ever-lower levels. The last major push regarding this came about as recommendations from the so-called National Cholesterol Education Panel (NCEP) in the US in 2004. The NCEP’s focus here was on getting LDL levels lower, irrespective of anything else. It subsequently turned out that 8 of the 9 members of the NCEP had financial links with companies making cholesterol-reducing medication. These links were not disclosed at the time the panel’s recommendations were made public.

Why would this panel shift the focus totally on to LDL, despite the evidence that cholesterol ratios are a better predictor of risk? One reason might be that if we calculated risk on the basis of ratios, far less individuals would be deemed appropriate for drug treatment. If someone is being paid (often substantial sums) by drug companies, the tendency will be to make recommendations that help those companies, right? And the tendency, also, will be not to make any recommendations that harm those companies.

The conflicts of interest rife among NCEP members is suspicious, but it does not prove anything. However, it is perhaps worth bearing in mind that independent review of the NCEP’s recommendations revealed they were not founded on good science at all [2]. It seems to me, that some doctors and scientists may be prioritising personal and corporate profit over public health.

Here’s to a healthy heart

Dr John Briffa
Editor
for The Cholesterol Truth



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Bear in mind we are not addressing anyone’s personal situation and you should rely on this for informational purposes only. Please consult with your own physician before acting on any recommendations contained herein.


References:

1. Natarajan S, et al. Cholesterol measures to identify and treat individuals at risk for coronary heart disease. Am J Prev Med. 2003;25(1):50-7.

2. Hayward RA, et al. Narrative review: lack of evidence for recommended low-density lipoprotein treatment targets: a solvable problem. Ann Int Med 2006;145:520-530

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Category: What Doctors Don't Tell You

Comments (8)

Testimonials are based on the personal experience of individuals. Results are not typical and the potential benefits of taking any drug or supplement may vary depending on your individual needs and health requirements. Please consult your GP before making any changes to your medical regimen.

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  2. Heni says:

    Interesting. Is this attitude more prevalent in the US than the UK? I ask because I got a cholesterol test back today. I’m a 27 year old woman, healthy weight, have a good diet, exercise a lot. My GP here in the UK told me that my total cholesterol was 6.6 but since my ratio was only 2.5, I had absolutely nothing to worry about. Is this not common wisdom anymore?

    • admin says:

      As a matter of fact, it is not common wisdom and your GP sounds like an exception to the rule.

  3. Mary says:

    I have come off statins 2 weeks ago,and I am beginning to get my strenght back after mnts of been on statins,i am now on a diet and watch my colestral levels, I am beginning to feel alot better now.

  4. Carl says:

    Wise words, Dr Briffa! Considering cholesterol ratios makes real sense. Many of my friends and relatives don’t even know that cholesterol can be “good” and “bad” – the word cholesterol is synonymous to “danger” for them while we really need fats, healthy ones. It’s the same as saying that a person consuming too many calories is about to die from obesity, without taking into account how much energy he actually spends. So I didn’t know until I faced the cholesterol problem myself. I didn’t like the idea of taking statins and I did just for a few months. I’m fine now because I gave up smoking, fastfood, meat and never skip workouts now, I don’t want to get back to statins. I don’t really know if my health was actually in danger then.

  5. melissa putt says:

    Thank-you Dr. Briffa. This message is so needed. Lets spread the word. I mention this in my book “The Last Tango with Butter,” It is important that everyone hears.

  6. BFB says:

    http://vimeo.com/24821365 – all the evidence you’ll ever need that suggestions made in this article are true. The video is available for free until 20 June. Please watch it, it’s a real eye-opener.

  7. ruelmain says:

    There’s an interesting emotional commitment to the cholesterol thoery. I tried to tell my (French) doctor that I wasn’t interested in reducing my cholesterol (having had bad experiences with fenofibrates and statins). I showed him your article about false targets with respect to Fenofibrates. First he wanted to establish that you were not American – illogically seen I think as unreliable. and then he read the first sentence (about prescribing Fenrofibrates with statins)  and said  in effect “we don’t do that in France” and didn’t read on. Then I showed him an article about Uffe Ravnskow written by a female interviewer. First question “is she American too” ? I said no, and its a man, and he’s Norwegian. “Oh well they eat a lot of fried food there”. Didn’t read the article at all. Finally he said that in all his years of doctoring he had seen a dramatic decline in heart disease, attributable to statins, and cited the case of a young man who smoked and drank a lot, and who was overweight. This poor young man died after about ten years, and by implication such a case would not be seen nowadays. I don’t think doctors really understand what they are doing. Mine’s very high on people skills and caring, and commitment but I recoil from being treated by him any more and am seeking a more holistic approach, i.e. to stop regarding the bits of the human body as unrelated pieces of machinery wherein a few cogs and sprockets can be tampered with to achieve a result. “Magic bullets” are really rare. Charles Marriage

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