Which of the following is maximally associated with hea disease
Serum cholesterol as a risk factor for CHD It is nearly three decades since it became clear that elevation of serum cholesterol was one of the factors which carried an increased risk for the development of myocardial infarction. Today, there is a vast body of evidence showing a triangular relationship between habitual diet, blood cholesterol-lipoprotein levels and CHD, and that these relationships are judged to be causal. There is no population, in which CHD is common, that does not also have a relatively high mean level of cholesterol (i.e. greater than 200 mg/di in adults), which shows the cultural differences in serum cholesterol levels between two countries. Among Japan and Finland, Japan having the lowest incidence and Finland the highest incidence of CHD. The strength of the dietary-fat hypothesis is that observations in the Seven Countries Study (among others) fitted it well that is, the Japanese had low fat diets, low serum cholesterol and low incidence of CHD while the East Fins were at the other extreme. The weakness of the hypothesis is that studies of individuals have not shown such a relationship. This has been attributed to genetic and dietary intake differences between individuals. When we look at the various types of. lipoproteins, it is the level of low-density lipoprotein (LDL) cholesterol that is most directly associated with CHD. While very low- density lipoprotein (VLDL) has also been shown to be associated with premature atherosclerosis, it is more strongly associated with peripheral vascular disease (e.g., intermittent claudication) than with CHD. High-density lipoprotein (HDL) cholesterol is protective against the development of CHD- the higher its mean level in a group of individuals, the lower the incidence of infarction in that group. HDL should be more than 40 mg/dl. To fuher refine CHD risk prediction based on serum lipid levels, a total "cholesterol/HDL ratio" has been developed. A ratio of less than 3.5 has been recommended as a clinical goal for CHD prevention. With newer techniques, high-density and low-density lipoproteins have been fuher subdivided into sub-fractions. Recent evidence indicates that levels of plasma apolipoprotein-A-1 (the major HDL protein) and apolipoprotein-B (the major LDL protein) are better predictors of CHD than HDL cholesterol or LDL cholesterol respectively. Therefore, measurement of apolipoproteins may replace lipoprotein cholesterol determinations in assessing the risk of CHD Ref: Park 25th edition Pgno : 387
HDL
LDL
VLDL
Chylomicrons
Non communicable diseases