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| |  Changes in Cholesterol Ratios -Not Levels- is a Better Measure of CHD Risk PHILADELPHIA, Oct. 31, 1995 -- Last fall, researchers at the University of Pennsylvania Medical Center concluded that the ratio of one's total cholesterol to high-density lipoprotein (HDL) cholesterol is a superior measure of determining coronary heart disease risk. This study challenged current national guidelines that recommend physicians measure only low-density lipoprotein (LDL) levels. In a subsequent study that will appear in the October issue of the Journal of Investigative Medicine, Bruce Kinosian, MD, Assistant Professor of Medicine, and Henry Glick, both at Penn Medical Center, evaluate various methods for determining the success of a prescribed treatment for lowering coronary heart disease risk. Using data from a study of 3,641 men in the Lipid Research Clinics Coronary Primary Prevention Trial, the authors found that changes in the ratios, as opposed to changes in LDL levels alone, more accurately measure changes in a patient's risk of coronary heart disease. Again, the study challenges current guidelines that state physicians should use the changes in LDL levels alone as a measure of treatment success. As Glick says, "By monitoring the ratio of total cholesterol to HDL, or the ratio of LDL to HDL, doctors will see the change in LDL, or `bad' cholesterol, as well as the change in HDL, or `good' cholesterol. By looking at both of these changes, doctors can more accurately determine if patients are benefiting from various treatments." For instance, some physicians recommend that patients follow a very restrictive, low-fat diet in order to reduce their LDL level. Often times the HDL level will drop as well, which means the treatment has a neutral -- and sometimes a negative -- effect on reducing coronary heart disease risk. By placing patients on a diet without the heavy restrictions, the patients may not have drastic reductions in their LDL levels, but their HDL levels may improve so much that the net result is much better. By following a less restrictive diet, not only will the quality of life improve for patients, but their coronary heart disease risk may improve as well. The results of this study also emphasize the importance of life-style changes, such as exercise, weight loss, and smoking cessation, which can help raise HDL levels. Similarly, patients may prefer drugs, such as a low-dose niacin, that lead to large increases in HDL levels and moderate reductions in LDL levels, as opposed to drugs that only lower LDL with little or no effect on HDL levels. As Dr. Kinosian says, "Physicians selecting treatment for intervention should include among their considerations the treatment's effect on both LDL and HDL cholesterol, rather than the effects on LDL cholesterol levels alone." Dr. Kinosian recommends that patients ask their primary care physicians about changes in both LDL and HDL cholesterol levels, which will more accurately measure their response to treatments and, therefore, their change in coronary heart disease risk. CONTACT: Seanna C. Walter of University of Pennsylvania Medical Center, 215-662-2098/ CO: University of Pennsylvania Medical Center ST: Pennsylvania IN: MTC SU:
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