Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2009;5:757-65.
Epub 2009 Sep 18.

Lipoprotein Ratios: Physiological Significance and Clinical Usefulness in Cardiovascular Prevention

Free PMC article

Lipoprotein Ratios: Physiological Significance and Clinical Usefulness in Cardiovascular Prevention

Jesús Millán et al. Vasc Health Risk Manag. .
Free PMC article


Low-density lipoprotein (LDL) cholesterol concentration has been the prime index of cardiovascular disease risk and the main target for therapy. However, several lipoprotein ratios or "atherogenic indices" have been defined in an attempt to optimize the predictive capacity of the lipid profile. In this review, we summarize their pathophysiological aspects, and highlight the rationale for using these lipoprotein ratios as cardiovascular risk factors in clinical practice, specifying their cut-off risk levels and a target for lipid-lowering therapy. Total/high-density lipoprotein (HDL) cholesterol and LDL/HDL cholesterol ratios are risk indicators with greater predictive value than isolated parameters used independently, particularly LDL. Future recommendations regarding the diagnosis and treatment of dyslipidemia, including instruments for calculating cardiovascular risk or action guidelines, should include the lipoprotein ratios with greater predictive power which, in view of the evidence-based results, are none other than those which include HDL cholesterol.

Keywords: apolipoproteins; cardiovascular disorders; cholesterol ratios; predictive power.


Figure 1
Figure 1
Atherogenic and anti-atherogenic lipoproteins. This diagram shows that there is one single apolipoprotein B (apoB) molecule in each large, buoyant or small, dense particle of very-low-density (VLDL), intermediate-density (IDL), and low-density lipoproteins (LDL). Therefore, apoB represents the total number of potentially atherogenic particles. Apolipoprotein A-I (apo A-I) is the principal protein component in high-density lipoproteins (HDL) and is responsible for starting reverse cholesterol transport. The balance between apoB and apoA-I is indicative of cardiovascular risk: the greater the ratio, the greater the risk. Abbreviations: TG, triglycerides; C, cholesterol; + +, increased risk; − −, reduced risk.
Figure 2
Figure 2
Impact of the apoB/apoA-I ratio on atherogenic balance. Abbreviation: Apo, apolipoproteins.

Similar articles

See all similar articles

Cited by 129 articles

See all "Cited by" articles


    1. Yusuf S, Hawken S, Öunpuu S, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364:937–952. - PubMed
    1. Superko HR, King S., III Lipid management to reduce cardiovascular risk: a new strategy is required. Circulation. 2008;117:560–568. - PubMed
    1. Arad Y, Goodman KJ, Roth M, Newstein D, Guerci AD. Coronary calcification, coronary disease risk factors, C-reactive protein, and atherosclerotic cardiovascular disease events: the St. Francis Heart Study. J Am Coll Cardiol. 2005;46:158–165. - PubMed
    1. Ascaso J, González Santos P, Hernández Mijares A, et al. Management of dyslipidemia in the metabolic syndrome. Recommendations of the Spanish HDL Forum. Am J Cardiovasc Drugs. 2007;7:39–58. - PubMed
    1. Kinosian B, Glick H, Garland G. Cholesterol and coronary heart disease: predicting risks by levels and ratios. Ann Intern Med. 1994;121:641–647. - PubMed

MeSH terms

LinkOut - more resources