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. 2019 Oct 29;19(1):239.
doi: 10.1186/s12872-019-1228-7.

The ratio of total cholesterol to high density lipoprotein cholesterol and myocardial infarction in Women's health in the Lund area (WHILA): a 17-year follow-up cohort study

Susanna Calling  1   2   3 , Sven-Erik Johansson  4 , Moa Wolff  4   5 , Jan Sundquist  4   5 , Kristina Sundquist  4   5
Affiliations

The ratio of total cholesterol to high density lipoprotein cholesterol and myocardial infarction in Women's health in the Lund area (WHILA): a 17-year follow-up cohort study

Susanna Calling et al. BMC Cardiovasc Disord. .

Abstract

Background: Identifying variables predictive of acute myocardial infarction (AMI) in women is important. The use of the ratio of total cholesterol-to-high density lipoprotein cholesterol (TC/HDL-C) is often overlooked. The aim was to study TC/HDL-C in relation to later AMI, in a large sample of women, adjusted for age, educational status, smoking, waist-hip ratio, blood pressure, and neighbourhood socioeconomic status. The hypothesis was that increasing TC/HDL-C is associated with an increased risk of later AMI.

Methods: From December 1995 to February 2000, 6147 women aged 50-59 years from the Womens' Health in Lund area (WHILA) study in southern Sweden underwent a physical examination, laboratory tests and filled in a questionnaire. The women were followed through national registers for incidence of AMI during a mean follow up of 17 years.

Results: An increasing TC/HDL-C showed a strong relationship with AMI, with the lowest hazard ratio (HR = 1) in women with a ratio of ≤3.5. The HR for AMI was 1.14 (95% CI: 0.73-1.78) for those with a ratio between 3.5 and 4.0; in those with a ratio between 4.0 and 5.0 the HR for AMI was 1.46 (95% CI: 1.00-2.13) and in those with a ratio > 5.0 the HR was 1.89 (95% CI 1.26-2.82), after adjusting for potential confounding factors.

Conclusions: TC/HDL-C ratio is a powerful predictor of AMI in middle-aged women. The results indicate that this variable should be used in clinical practice and is important for early identification of individuals at risk of AMI.

Keywords: Cardiovascular diseases, women; Cholesterol, HDL; Hyperlipidemias; Lipoproteins; Myocardial infarction.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Hazard ratios (HR) with 95% confidence interval (CI) for AMI and TC/HDL-C ratio. Legend: HR estimated by restricted cubic splines. The model is adjusted for age. Those with AMI before screening were excluded. n = 6147; AMI = 191
Fig. 2
Fig. 2
Hazard ratios (HR) with 95% confidence interval (CI) for AMI and TC/HDL-C ratio. Legend: HR estimated by restricted cubic splines. The model is adjusted for all other variables. Those with AMI before screening were excluded. n = 6147; AMI = 191
See this image and copyright information in PMC

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