Implications of Total to High-Density Lipoprotein Cholesterol Ratio Discordance With Alternative Lipid Parameters for Coronary Atheroma Progression and Cardiovascular Events

Mohamed B. Elshazly, Stephen J. Nicholls, Steven E. Nissen, Julie St. John, Seth S. Martin, Steven R. Jones, Renato Quispe, Brian Stegman, Samir R. Kapadia, E. Murat Tuzcu, Rishi Puri

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9 Citations (Scopus)


The total cholesterol to high-density lipoprotein cholesterol (TC/HDL-C) ratio may quantify atherogenic lipoproteins beyond low-density lipoprotein cholesterol (LDL-C), non-HDL-C and apolipoprotein B (apoB). We analyzed pooled data from 9 trials involving 4,957 patients with coronary artery disease undergoing serial intravascular ultrasonography to assess changes in percent atheroma volume (ΔPAV) and 2-year major adverse cardiovascular event (MACE) rates when TC/HDL-C levels were discordant with LDL-C, non-HDL-C, and apoB. Discordance was investigated when lipid levels were stratified by </≥median levels (TC/HDL-C 3.3 vs LDL-C 80, non-HDL-C 107, and apoB 76 mg/dl) or </≥very low percentile equivalent cutoffs (TC/HDL-C 2.5 vs LDL-C 70, non-HDL-C 89, and apoB 59 mg/dl). When stratified by median levels, TC/HDL-C was commonly observed to be discordant with LDL-C (26%), non-HDL-C (20%), and apoB (27%). In patients with LDL-C, non-HDL-C, or apoB <median, those with a discordant TC/HDL-C ≥median demonstrated less PAV regression and greater MACE (18.9%, 17.7%, 19.8%, respectively) compared with TC/HDL-C <median (14.4%, 14.0%, 12.8%; p = 0.02, 0.14, 0.003, respectively). In patients with LDL-C, non-HDL-C, or apoB ≥median, those with a discordant TC/HDL-C <median demonstrated less PAV progression and lower MACE (15.0%, 17.3%, 19.9%, respectively) compared with TC/HDL-C ≥median (24.7%, 24.2%, 26.4%; p <0.001, 0.003, 0.03, respectively). In conclusion, the TC/HDL-C ratio reclassifies atheroma progression and MACE rates when discordant with LDL-C, non-HDL-C, and apoB within subjects. Thus, using the ratio, in addition to individual lipid parameters, may identify patients who may benefit from more intensive lipid modification.

Original languageEnglish
Pages (from-to)647-655
Number of pages9
JournalAmerican Journal of Cardiology
Issue number5
Publication statusPublished - 1 Jan 2016

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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