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Prediction of Cardiovascular Mortality
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It seems to me that the recent article by Cui et al1
demonstrating non–high-denisty lipoprotein cholesterol (HDL-C) to be
a better predictor of cardiovascular disease (CVD) mortality than low-density
lipoprotein cholesterol (LDL-C) was basically a reformulation of an already
recognized phenomenon, namely, that a formula including HDL-C is superior
to one neglecting it. Several authors have demonstrated that the ratio of
total cholesterol (TC) to HDL-C is superior to LDL-C in predicting CVD.2-5
Ciu et al1 simply substitute the difference between TC and HDL-C
for the ratio of the two; it is therefore not surprising that their value
should also be superior to LDL-C.
The interesting question is whether there is anything to be gained by
replacing the ratio of TC to HDL-C with the difference between the two. Do
the authors have any information on that comparison?
John I. Levitt, MD
Minneapolis, Minn
1. Cui Y, Blumenthal RS, Flaws JA, et al. Non–high-density lipoprotein cholesterol level as a predictor
of cardiovascular disease mortality. Arch Intern Med. 2001;161:1413-1419.
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2. Kinosian B, Glick H, Preiss L, Puder KL. Cholesterol and coronary heart disease: predicting risk in men by changes
in levels and ratio. J Investig Med. 1995;43:443-450.
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3. Criqui MH, Golomb BA. Epidemiologic aspects of lipid abnormalities. Am J Med. 1998;105:48S-57S.
4. Kannel WB, Wilson PWF. Efficacy of lipid profiles in prediction of coronary disease. Am Heart J. 1992;124:768-774.
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5. Castelli WP. Cholesterol and lipids in the risk of coronary artery disease–the
Framingham Heart Study. Can J Cardiol. 1988;4(suppl A):5A-10A.
Arch Intern Med. 2002;162:108.
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