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Review
. 2009;5:757-65.
Epub 2009 Sep 18.

Lipoprotein Ratios: Physiological Significance and Clinical Usefulness in Cardiovascular Prevention

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Free PMC article
Review

Lipoprotein Ratios: Physiological Significance and Clinical Usefulness in Cardiovascular Prevention

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

Abstract

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.

Figures

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.

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