The ratio of total cholesterol to high density lipoprotein cholesterol and myocardial infarction in Women’s health in the Lund area (WHILA): a 17-year follow-up cohort study
Open accessAbstract
Background: Identifying variables predictive of acute myocardial infarction (AMI) in women is important. The use of the ratio of total cholesterol-to-high density lipoprotein cholesterol (TC/HDL-C) is often overlooked. The aim was to study TC/HDL-C in relation to later AMI, in a large sample of women, adjusted for age, educational status, smoking, waist-hip ratio, blood pressure, and neighbourhood socioeconomic status. The hypothesis was that increasing TC/HDL-C is associated with an increased risk of later AMI. Methods: From December 1995 to February 2000, 6147 women aged 50–59 years from the Womens’ Health in Lund area (WHILA) study in southern Sweden underwent a physical examination, laboratory tests and filled in a questionnaire. The women were followed through national registers for incidence of AMI during a mean follow up of 17 years. Results: An increasing TC/HDL-C showed a strong relationship with AMI, with the lowest hazard ratio (HR = 1) in women with a ratio of ≤3.5. The HR for AMI was 1.14 (95% CI: 0.73–1.78) for those with a ratio between 3.5 and 4.0; in those with a ratio between 4.0 and 5.0 the HR for AMI was 1.46 (95% CI: 1.00–2.13) and in those with a ratio > 5.0 the HR was 1.89 (95% CI 1.26–2.82), after adjusting for potential confounding factors. Conclusions: TC/HDL-C ratio is a powerful predictor of AMI in middle-aged women. The results indicate that this variable should be used in clinical practice and is important for early identification of individuals at risk of AMI.
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A recent 17-year follow-up study of females concluded that the TC/HDL-C ratio was a potent predictor of cardiovascular disease events.
“A recent 17-year follow-up study of females concluded the TC/HDL-C ratio was a potent predictor of CVD events [4].”
From Estimating the Effect of Aerobic Exercise Training on Novel Lipid Biomarkers: A Systematic Review and Multivariate Meta-Analysis of Randomized Controlled Trials (2023) · cites this paper as [4]
The Abstract Conclusions call TC/HDL-C a powerful predictor of acute myocardial infarction (AMI) in middle-aged women, and the Discussion reports a strong association over a mean 17-year follow-up. The cited study examined AMI, not cardiovascular disease events broadly, so the claim extends its conclusion beyond the studied outcome. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThese cardiovascular disease risk biomarkers appear to be superior predictors of cardiovascular disease risk compared to the standard lipid profile.
“which appear to be superior predictors of CVD risk compared to the SLP [4, 5, 9–14].”
From Estimating the Effect of Aerobic Exercise Training on Novel Lipid Biomarkers: A Systematic Review and Multivariate Meta-Analysis of Randomized Controlled Trials (2023) · cites this paper as [4]
The Discussion (page unavailable) reports that a higher TC/HDL-C ratio was associated with greater acute myocardial infarction risk in middle-aged women. It does not establish that this ratio—or cardiovascular biomarkers generally—predicts cardiovascular disease better than a standard lipid profile; the Background notes a study finding no advantage over total cholesterol alone. (LLM, conf=0.87)
Experimental — accuracy not yet measured
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- Authors
- Calling, S., Johansson, S.-E., Wolff, M., Sundquist, J., & Sundquist, K.
- Affiliations
- Lund University (SE)
- Skåne University Hospital (SE)
- Corresponding author
- Calling, Susanna
- Venue
- BMC Cardiovascular Disorders
- Published
- 2019-10-29
- Volume
- 19
- Issue
- 1
- Pages
- 239-239
- ISSN
- 1471-2261 (ISSN-L)
- PMC
- PMC6821014
- OpenAlex
- W2982700518
- Cited by
- 60
- References
- 56
- Citations by year
- 2026: 6 · 2025: 13 · 2024: 15 · 2023: 4 · 2022: 9 · 2021: 9 · 2020: 4
- FWCI
- 5.26
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Cardiovascular Disorders (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Lund University Publications (Lund University) (submittedVersion)
- Funders
- National Heart, Lung, and Blood Institute (R01HL116381)
- Vetenskapsrådet
- ALF, Region Skåne
- Hjärt-Lungfonden
- Topics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Keywords
- TC/HDL-C ratio, acute myocardial infarction, women, middle-aged women, cardiovascular risk prediction, risk factors
- MeSH terms
- Cholesterol, Female, Follow-Up Studies, Humans, Cholesterol, HDL, Middle Aged, Myocardial Infarction, Predictive Value of Tests, Prognosis, Prospective Studies, Risk Factors, Sweden, Time Factors, Biomarkers, Women's Health, Risk Assessment, Dyslipidemias
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