Best predictor for coronary aery disease aEUR'
LDL ???? Elevated LDL cholesterol and decreased HDL cholesterol are independent predictors of coronary hea disease. - Although there is consensus regarding the benefits of lowering LDL cholesterol the value of elevating HDL cholesterol remains controversial. Low HDL and coronary risk High serum HDL cholesterol is associated with a lower risk of CHD. The incidence of CHD events in a normal population appears to be inversely related to serum HDL cholesterol with low levels being associated with increased coronary risk. - Based upon data .from the Framingham Hea study, the risk for myocardial infarction increases by about 25%.for every 5mg/d1 (.13 nuno1/1) decrement in serum HDL cholesterol. Elevated LDL and coronary risk Elevation in LDL cholesterol is a well known risk factor for the development of coronary aery disease. Association of elevated LDL with coronary aery disease has been established in various trials and studies. There is linear reduction in cardiovascular disease with progressive lowering of the LDL cholesterol. Traditionally LDL levels are considered to be the nzost impoant factor in the prediction of coronary aery disease. The impoance of LDL as a risk factor lies in the fact that effective therapes are avalaible to lower it, while it is not so in the case of HDL. So when treating dyslipidemia for reducing cardiovascular events, the .first target is LDL and not HDL. Doubt and Controversy What is creating doubts in our mind is a table from Braunwald 8th/e p1008 according to which 'Low HDL' appears to be better marker, for prediction of future cardiovascular disease than 'High LDL'. According to this bar diagram in Braunnwald 8"Ye p1008 - the adjusted hazard ratio .for .future cardiovascular events for LDL is 1.62 while that of HDL is 2.32. But the text given in the book does clarify which one is better marker. (we have give this table from Braunwald in our previous discussion on this topic in Nov 2009 Medicine). We have tried to confirm this low HDL' fact from various other books. But none of the texts clearly. ored any one between these 2 to be the better marker. Both LDL and HDL are mentioned to be impoant. We have also consulted several cardiologist on this. All of them say that the answer should be LDL Well, Braunwald is text book of immense reputation. and any information or text given in the book does not need confirmation from any other source. But what has added to the confusion is that the latest edition of Braunwald i.e., 9"/e has eliminated that diagram from the book and in the text have not clarified which one is better marker. Instead, the text states that Apolipo (a) and B 100 are better marker, .for predicting future cardiovascular events than LDL and HDL. We are not absolutely sure of the answer, but we would for the time being go with LDL. Also Know The following lipid and lipoprotein abnormalities are associated with increased coronary risk. - Elevated total cholesterol - Elevated LDL cholesterol Low HDL cholesterol - Increased total to HDL cholesterol ratio - Increased non HDL cholesterol - Hyperiglyceridemia - Increased Lp(a) - Increased apolipoprotein B - Sinai! dense LDL paicles
HDL
LDL
VLDL
Chylomicron