Serum Low-Density Lipoprotein to High-Density Lipoprotein Ratio as a Predictor of Future Acute Myocardial Infarction Among Men in a 2.7-Year Cohort Study of a Japanese Northern Rural Population

Abstract

Aim: To examine and compare the predictive value of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), TC/HDL-C and LDL-C/HDL-C ratios for future cardiovascular outcomes in the general Japanese population. Methods: A total of 24,566 eligible participants aged 18 years or older, without cardiovascular disease, were enrolled through multiphase health screening and divided into quartile groups based on lipoprotein levels or ratios. Primary endpoints of the study were definitive acute myocardial infarction (AMI) and ischemic stroke, and cases of sudden death with unknown causes were not included. We used Cox proportional hazard models to examine the relationships between the quartiles and incidences of AMI or ischemic stroke, adjusting for traditional risk factors. Results: Mean age was 63.7 years for males and 60.7 years for females. Mean follow-up period was 2.7 years, and 40 cases of AMI and 182 cases of ischemic stroke were recorded. The hazard ratio (HR) for AMI was significantly higher in the top quartile of the LDL-C/HDL-C ratio and LDL-C levels, and third quartile of TC among male participants. The HR of male participants with a LDL-C/HDL-C ratio of 2.6 or higher was significantly higher than other quartiles. No association between lipoprotein levels or their ratio quartiles and ischemic stroke was seen for either sex after adjusting for risk factors. Conclusions: Our results indicated that the LDL-C/HDL-C ratio is an independent predictor for AMI, and the importance of better management of cardiovascular risks among people with high LDLC/HDLC ratios for the prevention of future cardiovascular disease. J Atheroscler Thromb, 2011; 18:89-98.

Low-Dose Rosuvastatin Improves Arterial Stiffness in High-Risk Japanese Patients With Dyslipdemia in a Primary Prevention Group - A Comparison With Fluvastatin -

“…Recent studies conducted in Japan have suggested the L/H ratio as a predictor of clinical outcomes in patients after percutaneous coronary intervention, 33 and in the general population. 34 Functional improvement observed in the present study corresponded well with the recent finding by Otagiri et al, 35 who found beneficial vascular structural changes, including a significant reduction of lipid components of the coronary plaque, in Japanese patients with ACS following early administration of low-dose rosuvastatin (2.5 mg/day up to 5 mg/day) for 6 months. In Protocol 2, all patients who had been switched from usual-dose fluvastatin to rosuvastatin attained the target LDL-C level at 12 months after the switch.…”

Usefulness of LDL-C-Related Parameters to Predict Cardiovascular Risk and Effect of Pravastatin in Mild-to-Moderate Hypercholesterolemia

“…The predictability of future CVD events has been well assessed in previous epidemiological studies of the general population 15,16) . These studies demonstrated the high reliability of HDL-C in predicting future CVD, and ratios incorporating HDL-C showed greater predictability of CVD than LDL-C or TG alone.…”

An International Atherosclerosis Society Position Paper: Global recommendations for the management of dyslipidemia

“…Italy, China, and Japan), baseline population risk appears to be unusually low (Menotti et al 1993;Campbell et al 1998;Yokokawa et al 2011). This may be due in part to a lifetime of relatively low LDL-C levels, but other poorly defined factors likely account for the low population risk.…”