Lemieux I, Lamarche B, Couillard C, Pascot A, Cantin B, Bergeron J, Dagenais G R, Després J P
Quebec Heart Institute, Laval Hospital Research Center, 2725, chemin Sainte-Foy, Sainte-Foy, Quebec G1V 4G5, Canada.
Arch Intern Med. 2001;161(22):2685-92. doi: 10.1001/archinte.161.22.2685.
Total cholesterol (TC)/high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C)/HDL-C ratios are used to predict ischemic heart disease risk. There is, however, no consensus on which of these 2 indices is superior. The objective of the present study was to present evidence that the LDL-C/HDL-C ratio may underestimate ischemic heart disease risk in overweight hyperinsulinemic patients with high triglyceride (TG)-low HDL-C dyslipidemia.
A total of 2103 middle-aged men in whom measurements of the metabolic profile were performed in the fasting state were recruited from 7 suburbs of the Quebec metropolitan area.
The relationship of LDL-C/HDL-C to TC/HDL-C ratios was examined among men in the Quebec Cardiovascular Study classified into tertiles of fasting TG levels. For any given LDL-C/HDL-C ratio, the TC/HDL-C ratio was higher among men in the top TG tertile (>168 mg/dL [>1.9 mmol/L]) than in men in the first and second TG tertiles. Adjustment of the TC/HDL-C ratio for LDL-C/HDL-C by covariance analysis generated significant differences in average TC/HDL-C ratios among TG tertiles (P<.001). Greater differences in features of the insulin resistance syndrome (insulinemia, apolipoprotein B, and LDL size) were noted across tertiles of the TC/HDL-C ratio than tertiles of the LDL-C/HDL-C ratio.
Variation in the TC/HDL-C ratio may be associated with more substantial alterations in metabolic indices predictive of ischemic heart disease risk and related to the insulin resistance syndrome than variation in the LDL-C/HDL-C ratio.
总胆固醇（TC）/高密度脂蛋白胆固醇（HDL-C）以及低密度脂蛋白胆固醇（LDL-C）/HDL-C比值用于预测缺血性心脏病风险。然而，关于这两个指标哪一个更具优势尚无共识。本研究的目的是提供证据表明，在超重、高胰岛素血症且伴有高甘油三酯（TG）-低HDL-C血脂异常的患者中，LDL-C/HDL-C比值可能低估缺血性心脏病风险。
从魁北克市区的7个郊区招募了总共2103名在空腹状态下进行代谢指标测量的中年男性。
在魁北克心血管研究中，将男性按照空腹TG水平分为三分位数，研究了LDL-C/HDL-C与TC/HDL-C比值之间的关系。对于任何给定的LDL-C/HDL-C比值，TG三分位数最高组（>168 mg/dL [>1.9 mmol/L]）男性的TC/HDL-C比值高于TG三分位数第一组和第二组的男性。通过协方差分析对LDL-C/HDL-C进行TC/HDL-C比值调整后，TG三分位数之间的平均TC/HDL-C比值存在显著差异（P<0.001）。与LDL-C/HDL-C比值三分位数相比，TC/HDL-C比值三分位数之间胰岛素抵抗综合征（胰岛素血症、载脂蛋白B和LDL大小）特征的差异更大。
与LDL-C/HDL-C比值变化相比，TC/HDL-C比值变化可能与预测缺血性心脏病风险且与胰岛素抵抗综合征相关的代谢指标的更显著改变有关。
