The ratio of total cholesterol to HDL-cholesterol is a good marker if you're low-risk
The ratio of apoB to apoA-1 may be better if you're high-risk
Cardiovascular diseases (CVD) kill more Americans than any other cause. Thus, it behooves us, especially those of us who are at higher risk for CVD, to monitor our risk of CVD. If you’re a higher risk person, your doctor probably advised you to get a blood test to determine your risk of CVD. Perhaps, you’ve thought of this blood test as a way to see how your cholesterol is doing.
Researchers have proposed several ways to calculate CVD risk. One initial marker was the concentration of total cholesterol in your blood serum. That proved to be unreliable, partly because cholesterol comprises a suite of substances, some of which predict higher risk of CVD, but some predict lower risk. More recently, LDL-cholesterol (the “bad” kind) became a widely used marker. Your doctor have been advised to keep your LDL-cholesterol below 130 mg/dL or, even better, below 100 mg/dL.
Another marker for CVD risk is the ratio of triglycerides (blood fats) to HDL-cholesterol (the “good” kind) in blood serum. Excessively high triglyceride levels predict increased risk of CVD. Thus, you want a low ratio. A recent study (Farrell et al. 2017) showed that risk of cardiovascular disease declined from the group with the highest triglyceride to HDL-cholesterol ratio (more than 3.90) to the group with the lowest ratio (less than 1.51) during 16 years of follow-up.
Perhaps the most commonly used CVD risk marker these days is the ratio of total cholesterol to HDL-cholesterol. A recent study using data from 346,868 participants in the UK Biobank (Welsh et al. 2019) found that the ratio of total cholesterol to HDL-cholesterol predicted CVD risk for healthy people. Plus, the researchers confirmed that overnight fasting—a major barrier for many people—was not necessary for valid blood test results.
Research shows that the ratio of alipoprotein B to alipoprotein A-I predicts CVD risk. Apolipoprotein B (usually referred to as apoB) is a molecule that’s the main component of very low density LDL-cholesterol. Simplistically stated, apoB transports fat particles to the cells. ApoA-1 is the main structural protein of HDL-cholesterol. ApoA-1 transports fat particles to the liver for reprocessing.
An accompanying editorial to the UK Biobank study (Mora et al. 2019) noted that serum concentration of apoB provided additional useful predictive information for study participants with high CVD risk. Thus, if you’re a person at high risk for CVD, the ratio of apoB to apoA-I might be a better measure.
Regardless of your CVD risk, you’ll do yourself a favor and lower your CVD risk by adopting the healthy choices of Keep Moving, Eat Better, and Defuse Chronic Stress.