Cheese and the dreaded cholestrol

[Eddy Edson]

A cholesterol of ten and HDL of two will give a "good" ratio of 5.

I get the feeling that "ratios" are kind of an embarassment now - none of the recent expert statements I've read have anything to say about them, and they generally all repeat findings that raising HDL doesn't do you any good - so making your "ratio" better by increasing your HDL while keeping everything else the same isn't going to reduce any risks.

That NHS England lipid guidelines now only speak of non-HDL targets, and not ratios, is telling; but it doesn't fit comfortably with eg QRISK3 still being driven by the total chol / HDL ratio.

On the other hand, the HDL ratios stuff seems particularly odd given the large number of high quality studies showing U-shaped relationships between CV risk and HDL levels. Having a lot of HDL beyond a threshhold is associated with increased risk, as is well understood. So how that's supposed to fit with "ratios" - who knows?

Eg - this huge study just published: https://academic.oup.com/eurjpc/advance-article/doi/10.1093/eurjpc/zwab230/6491266?login=true

Both low and high levels of HDL-C were associated with increased mortality from CVD in the general population .... High HDL-C levels are not necessarily a sign of good cardiovascular health, especially in younger adults.

 

[grovesy]

I have evenly had a Cholesterol chat with Dr., my surgery seem to be focusing on the the Cholesterol rather than the the ratio.

 

[Sharron1]

I was going by the ratios which appear on the print outs from the NHS that I get from my nurse, which say "under 3"

It is all so complicated as my ratio is 2.5 and trigs and HDL normal range but LDL abnormal range. TC is 5.6 which my clinic says is a bit high for a diabetic.

 

[Deleted member 21371]

I get the feeling that "ratios" are kind of an embarassment now - none of the recent expert statements I've read have anything to say about them, and they generally all repeat findings that raising HDL doesn't do you any good - so making your "ratio" better by increasing your HDL while keeping everything else the same isn't going to reduce any risks.

That NHS England lipid guidelines now only speak of non-HDL targets, and not ratios, is telling; but it doesn't fit comfortably with eg QRISK3 still being driven by the total chol / HDL ratio.

On the other hand, the HDL ratios stuff seems particularly odd given the large number of high quality studies showing U-shaped relationships between CV risk and HDL levels. Having a lot of HDL beyond a threshhold is associated with increased risk, as is well understood. So how that's supposed to fit with "ratios" - who knows?

Eg - this huge study just published: https://academic.oup.com/eurjpc/advance-article/doi/10.1093/eurjpc/zwab230/6491266?login=true

Both low and high levels of HDL-C were associated with increased mortality from CVD in the general population .... High HDL-C levels are not necessarily a sign of good cardiovascular health, especially in younger adults.

I've always seen the bathtub curve for HDL cholesterol, and it's never been good.
That's the main reason I stick with recognised figures.
Mind you, these curves usually associate with direct cases of death associated with cholesterol, as opposed to the "all causes" chart that is usually wheeled out to show people in third word countries with high starvation rates die with low measurable cholesterol.
Apparently, its not the lack of eating that kills you, its the lack of high cholesterol?
I'm not sure how that translates to a western diet.