Is High Serum LDL/HDL Cholesterol Ratio an Emerging Risk Factor for Sudden Cardiac Death? Findings from the KIHD Study
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AIM: Low-density lipoprotein cholesterol (LDL-c) and high-density lipoprotein cholesterol (HDL-c), which are components of total cholesterol, have each been suggested to be linked to the risk of sudden cardiac death (SCD). However, the relationship between LDL-c/HDL-c ratio and the risk of SCD has not been previously investigated. We aimed to assess the associations of LDL-c, HDL-c, and the ratio of LDL-c/HDL-c with the risk of SCD. METHODS: Serum lipoprotein concentrations were assessed at baseline in the Finnish Kuopio Ischemic Heart Disease prospective cohort study of 2,616 men aged 42-61 years at recruitment. Hazard ratios (HRs) (95% confidence intervals [CI]) were assessed. RESULTS: During a median follow-up of 23.0 years, a total of 228 SCDs occurred. There was no significant evidence of an association of LDL-c or HDL-c with the risk of SCD. In analyses adjusted for age, examination year, body mass index, systolic blood pressure, smoking, alcohol consumption, physical activity, years of education, diabetes, previous myocardial infarction, family history of coronary heart disease, and serum high sensitivity C-reactive protein, there was approximately a two-fold increase in the risk of SCD (HR 1.94, 95% CI 1.21-3.11; p=0.006), comparing the top (＞4.22) versus bottom (≤2.30) quintile of serum LDL-c/HDL-c ratio. CONCLUSION: In this middle-aged male population, LDL-c or HDL-c was not associated with the risk of SCD. However, a high serum LDL-c/HDL-c ratio was found to be independently associated with an increased risk of SCD. Further research is warranted to understand the mechanistic pathways underlying this association.
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The increase in HDL-C of 3.5 mg/dL could translate to an estimated 7-11% decrease in CVD risk according to epidemiological data.
“KD raised HDL-C by 3.5 mg/dL, which according to epidemiological data could translate to an estimated 7–11% decrease in CVD risk [27]”
From Ketogenic diet-induced changes in adult lipid metabolism: a comprehensive systematic review and meta-regression of randomized controlled trials (2026) · cites this paper as [27]
The Results report associations between lipoprotein levels and sudden cardiac death, but do not estimate the CVD-risk change associated with a 3.5 mg/dL rise in HDL-C. The Discussion cautions that higher HDL-C does not necessarily lower coronary risk. Searches for the 3.5 mg/dL change and the 7–11% estimate found neither in our copy. (LLM, conf=0.75)
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Cites
von Elm, E., Altman, D. G., Egger, M., Pocock, S. J., Gøtzsche, P. C., Vandenbroucke, J. P., & Initiative, F. T. S. (2007) · PLoS Medicine · doi:10.1371/journal.pmed.0040296 · Cited by 23,020 · see citing works
von Elm, E., Altman, D. G., Egger, M., Pocock, S. J., Gøtzsche, P. C., & Vandenbroucke, J. P. (2008) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2007.11.008 · Cited by 17,893 · see citing works
High density lipoprotein as a protective factor against coronary heart disease
Gordon, T., Castelli, W. P., Hjortland, M. C., Kannel, W. B., & Dawber, T. R. (1977) · The American Journal of Medicine · doi:10.1016/0002-9343(77)90874-9 · Cited by 5,059 · see citing works
Priori, S. G., Blomström-Lundqvist, C., Mazzanti, A., Blom, N., Borggrefe, M., Camm, J., Elliott, P. M., Fitzsimons, D., Hatala, R., Hindricks, G., et al. (2015) · European Heart Journal · doi:10.1093/eurheartj/ehv316 · Cited by 3,893 · see citing works
Nissen, S. E., Nicholls, S. J., Sipahi, I., Libby, P., Raichlen, J. S., Ballantyne, C. M., Davignon, J., Erbel, R., Fruchart, J. C., Tardif, J.-C., et al. (2006) · JAMA · doi:10.1001/jama.295.13.jpc60002 · Cited by 2,047 · see citing works
Low-Density Lipoprotein Subclass Patterns and Risk of Myocardial Infarction
Austin, M. A. (1988) · JAMA: The Journal of the American Medical Association · doi:10.1001/jama.1988.03410130125037 · Cited by 1,780 · see citing works
Authors Task Force Members, Priori, S. G., Blomström‐Lundqvist, C., Mazzanti, A., Blom, N. A., Borggrefe, M., Camm, J. A., Elliot, P. M., Fitzsimons, D., Hatala, R., et al. (2015) · EP Europace · doi:10.1093/europace/euv319 · Cited by 1,667 · see citing works
Salonen, J. T., Nyyssönen, K., Korpela, H., Tuomilehto, J., Seppänen, R., & Salonen, R. (1992) · Circulation · doi:10.1161/01.cir.86.3.803 · Cited by 1,284 · see citing works
Chugh, S. S., Jui, J., Gunson, K., Stecker, E. C., John, B. T., Thompson, B., Ilias-Khan, N. A., Vickers, C. A., Dogra, V., Daya, M. R., et al. (2004) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2004.06.029 · Cited by 793 · see citing works
Statins, high-density lipoprotein cholesterol, and regression of coronary atherosclerosis
Nicholls, S. J., Tuzcu, E. M., Sipahi, I., Grasso, A. W., Schoenhagen, P., Hu, T., Wolski, K., Crowe, T., Desai, M. Y., Hazen, S. L., et al. (2007) · JAMA · doi:10.1001/jama.297.5.499 · Cited by 724 · see citing works
The Spectrum of Epidemiology Underlying Sudden Cardiac Death
Hayashi, M., Shimizu, W., & Albert, C. M. (2015) · Circulation Research · doi:10.1161/circresaha.116.304521 · Cited by 719 · see citing works
Predicting Sudden Death in the Population
Jouven, X., Desnos, M., Guérot, C., & Ducimetière, P. (1999) · Circulation · doi:10.1161/01.cir.99.15.1978 · Cited by 642 · see citing works
Ingelsson, E., Schaefer, E. J., Contois, J. H., McNamara, J. R., Sullivan, L., Keyes, M. J., Pencina, M. J., Schoonmaker, C., Wilson, P. W. F., D’Agostino, R. B., et al. (2007) · JAMA · doi:10.1001/jama.298.7.776 · Cited by 608 · see citing works
Lipids, apolipoproteins, and their ratios in relation to cardiovascular events with statin treatment
Kastelein, J. J. P., van der Steeg, W. A., Holme, I., Gaffney, M., Cater, N. B., Barter, P., Deedwania, P., Olsson, A. G., Boekholdt, S. M., Demicco, D. A., et al. (2008) · Circulation · doi:10.1161/circulationaha.107.713438 · Cited by 478 · see citing works
Teramoto, T., Sasaki, J., Ishibashi, S., Birou, S., Daida, H., Dohi, S., Egusa, G., Hiro, T., Hirobe, K., Iida, M., et al. (2013) · Journal of Atherosclerosis and Thrombosis · doi:10.5551/jat.15792 · Cited by 468 · see citing works
The LDL modification hypothesis of atherogenesis: an update
Steinberg, D. H. (2008) · Journal of Lipid Research · doi:10.1194/jlr.r800087-jlr200 · Cited by 452 · see citing works
Prospective Study of Sudden Cardiac Death Among Women in the United States
Albert, C. M., Chae, C. U., Grodstein, F., Rose, L. M., Rexrode, K. M., Ruskin, J. N., Stampfer, M. J., & Manson, J. E. (2003) · Circulation · doi:10.1161/01.cir.0000065223.21530.11 · Cited by 421 · see citing works
Yoshida, H., & Kisugi, R. (2010) · Clinica Chimica Acta · doi:10.1016/j.cca.2010.08.038 · Cited by 289 · see citing works
Teramoto, T., Sasaki, J., Ueshima, H., Egusa, G., Kinoshita, M., Shimamoto, K., Daida, H., Biro, S., Hirobe, K., Funahashi, T., et al. (2007) · Journal of Atherosclerosis and Thrombosis · doi:10.5551/jat.14.45 · Cited by 265 · see citing works
Risk Factors for Sudden Cardiac Death in Middle-Aged British Men
Wannamethee, S. G., Shaper, A. G., Macfarlane, P. W., & Walker, M. (1995) · Circulation · doi:10.1161/01.cir.91.6.1749 · Cited by 210 · see citing works
Cardiorespiratory Fitness Is Related to the Risk of Sudden Cardiac Death
Laukkanen, J. A., Mäkikallio, T. H., Rauramaa, R., Kiviniemi, V. V., Ronkainen, K., & Kurl, S. (2010) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2010.05.043 · Cited by 177 · see citing works
Self-citationThe role of small, dense low density lipoprotein (LDL): a new look
Packard, C. J., CASLAKE, M. J., & Shepherd, J. (2000) · International Journal of Cardiology · doi:10.1016/s0167-5273(99)00107-2 · Cited by 170 · see citing works
Duration of QRS Complex in Resting Electrocardiogram Is a Predictor of Sudden Cardiac Death in Men
Kurl, S., Mäkikallio, T. H., Rautaharju, P. M., Kiviniemi, V. V., & Laukkanen, J. A. (2012) · Circulation · doi:10.1161/circulationaha.111.025577 · Cited by 161 · see citing works
Self-citationDeterminants of Arterial Wall Remodeling During Lipid-Lowering Therapy
Schoenhagen, P., Tuzcu, E. M., Apperson-Hansen, C., Wang, C., Wolski, K., Lin, S., Sipahi, İ., Nicholls, S. J., Magyar, W. A., Loyd, A., et al. (2006) · Circulation · doi:10.1161/circulationaha.105.585703 · Cited by 156 · see citing works
The incidence of sudden cardiac death in the general population
Straus, S. M. J. M., Bleumink, G. S., Dieleman, J. P., et al. (2004) · Journal of Clinical Epidemiology · doi:10.1016/s0895-4356(03)00210-5 · Cited by 133 · see citing works
Mabuchi, H., Kita, T., Matsuzaki, M., Matsuzawa, Y., Nakaya, N., Oikawa, S., Saito, Y., Sasaki, J., Shimamoto, K., Itakura, H., et al. (2002) · Circulation Journal · doi:10.1253/circj.66.1096 · Cited by 132 · see citing works
Efficacy of lipid profiles in prediction of coronary disease
Kannel, W. B., & Wilson, P. W. F. (1992) · American Heart Journal · doi:10.1016/0002-8703(92)90288-7 · Cited by 128 · see citing works
Salonen, J., Salonen, R. M., Seppänen, K., Rinta-Kiikka, S., Kuukka, M., Korpela, H., Alfthan, G., Kantola, M., & Schalch, W. (1991) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/53.5.1222 · Cited by 124 · see citing works
A biological approach to sudden cardiac death: Structure, function and cause
Myerburg, R. J., Kessler, K. M., Bassett, A. L., & Castellanos, A. (1989) · The American Journal of Cardiology · doi:10.1016/0002-9149(89)90017-9 · Cited by 121 · see citing works
Packard, C. J., Ford, I., Robertson, M., Shepherd, J., Blauw, G. J., Murphy, M. B., Bollen, E. L. E. M., Buckley, B. M., Cobbe, S. M., Gaw, A., et al. (2005) · Circulation · doi:10.1161/circulationaha.104.526848 · Cited by 121 · see citing works
Sudden cardiac death in diabetes mellitus: risk factors in the Rochester diabetic neuropathy study
Suarez, G. A. (2005) · Journal of Neurology, Neurosurgery & Psychiatry · doi:10.1136/jnnp.2004.039339 · Cited by 109 · see citing works
Small, dense low‐density‐lipoproteins and the metabolic syndrome
Rizzo, M., & Berneis, K. K. (2006) · Diabetes/Metabolism Research and Reviews · doi:10.1002/dmrr.694 · Cited by 91 · see citing works
Geographic variation in sudden coronary death
Gillum, R. F. (1990) · American Heart Journal · doi:10.1016/s0002-8703(05)80031-6 · Cited by 87 · see citing works
Takeichi, S., Yukawa, N., Nakajima, Y., Osawa, M., Saito, T., Seto, Y., Nakano, T., Saniabadi, A. R., Adachi, M., Wang, T., et al. (1999) · Atherosclerosis · doi:10.1016/s0021-9150(98)00246-9 · Cited by 79 · see citing works
Hsia, S. H., Pan, D., Berookim, P., & Lee, M. L. (2006) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2006.05.024 · Cited by 73 · see citing works
Hirata, A., Okamura, T., Sugiyama, D., Kuwabara, K., Kadota, A., Fujiyoshi, A., Miura, K., Okuda, N., Ohkubo, T., Okayama, A., et al. (2016) · Journal of Atherosclerosis and Thrombosis · doi:10.5551/jat.33449 · Cited by 61 · see citing works
Risk Stratification of Dyslipidemia: Insights from the Framingham Study
Wb, K. (2005) · Current Medicinal Chemistry - Cardiovascular & Hematological Agents · doi:10.2174/1568016054368250 · Cited by 59 · see citing works
Kimura, T., Itoh, T., Fusazaki, T., Matsui, H., Sugawara, S., Ogino, Y., Endô, H., Kobayashi, K., & Nakamura, M. (2010) · Circulation Journal · doi:10.1253/circj.cj-09-0849 · Cited by 54 · see citing works
Cardiorespiratory Fitness, LDL Cholesterol, and CHD Mortality in Men
Farrell, S. W., Finley, C. E., & Grundy, S. M. (2012) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0b013e31826524be · Cited by 39 · see citing works
Moriyama, K., & Takahashi, E. (2016) · Journal of Atherosclerosis and Thrombosis · doi:10.5551/jat.33985 · Cited by 39 · see citing works
King, D. E., Mainous, A. G., Matheson, E. M., & Everett, C. J. (2011) · European Journal of Preventive Cardiology · doi:10.1177/1741826711425776 · Cited by 32 · see citing works
Nakajima, K., Nakajima, Y., Takeichi, S., & Fujita, M. (2007) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2007.09.016 · Cited by 27 · see citing works
Viles-González, J. F., Fuster, V., Corti, R., & Badimón, J. J. (2003) · Current Opinion in Cardiology · doi:10.1097/00001573-200307000-00008 · Cited by 25 · see citing works
Pauciullo, P., Gentile, M., Marotta, G., Baiano, A., Ubaldi, S., Jossa, F., Iannuzzo, G., Faccenda, F., Panico, S., & Rubba, P. (2008) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2008.07.004 · Cited by 24 · see citing works
Kunutsor, S. K., Khan, H., & Laukkanen, J. A. (2016) · Journal of the American Heart Association · doi:10.1161/jaha.115.002858 · Cited by 24 · see citing works
Self-citationHigh-Density Lipoprotein Mimetics: a Therapeutic Tool for Atherosclerotic Diseases
Ikenaga, M., Higaki, Y., Saku, K., & Uehara, Y. (2016) · Journal of Atherosclerosis and Thrombosis · doi:10.5551/jat.33720 · Cited by 24 · see citing works
Changes in HDL cholesterol and cardiovascular outcomes after lipid modification therapy
Ray, K. K., Wainwright, N. W. J., Visser, L. E., Witteman, J. C. M., Breteler, M. M. B., Ambegaonkar, B. M., Albert Hofman, D., Stricker, B. H. C., Wareham, N. J., Khaw, K., et al. (2012) · Heart · doi:10.1136/heartjnl-2011-301405 · Cited by 21 · see citing works
Vasculoprotective Effects of Apolipoprotein Mimetic Peptides: An Evolving Paradigm in HDL Therapy
White, C. R., Datta, G., Mochon, P., Zhang, Z., Kelly, O., Curcio, C. A., Parks, D. A., Palgunachari, M. N., Handattu, S. P., Gupta, H., et al. (2009) · Vascular Disease Prevention · doi:10.2174/1567270000906010122 · Cited by 19 · see citing works
Kim, J. H., Jeong, M. H., Hong, Y. J., Lee, K. H., Kim, I. S., Choi, Y. H., Lee, M. G., Park, K. H., Sim, D. S., Kim, J. H., et al. (2012) · Korean Circulation Journal · doi:10.4070/kcj.2012.42.4.246 · Cited by 13 · see citing works
Vasculoprotective Effects of Apolipoprotein Mimetic Peptides: An Evolving Paradigm in HDL Therapy
White, C. R., Datta, G., Mochon, P., et al. (2009) · Vascular Disease Prevention · doi:10.2174/1567270001006010122 · Cited by 12 · see citing works
A novel impedance-based tomography approach for stenotic plaque detection: A simulation study
Yang, F., & PATTERSON, R. P. (2009) · International Journal of Cardiology · doi:10.1016/j.ijcard.2009.01.059 · Cited by 11 · see citing works
Goswami, B., Rajappa, M., Chakraborty, B., Patra, S. K., Kumar, S., & Mallika, V. (2012) · Clinical Biochemistry · doi:10.1016/j.clinbiochem.2012.01.019 · Cited by 5 · see citing works
Goswami, B., Rajappa, M., Singh, B., et al. (2011) · Atherosclerosis Supplements · doi:10.1016/s1567-5688(11)70530-x · Cited by 2 · see citing works
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Huang, J.-B., Chen, Y.-S., Ji, H.-Y., Xie, W.-M., Jiang, J., Ran, L.-S., Zhang, C.-T., & Quan, X.-Q. (2020) · Lipids in Health and Disease · doi:10.1186/s12944-020-01238-2 · Cited by 123 · see citing works
Zhao, J., Wei, C., Gong, F., Pang, Z., & Zhao, H. (2026) · BMC Cardiovascular Disorders · doi:10.1186/s12872-026-05799-5
“KD raised HDL-C by 3.5 mg/dL, which according to epidemiological data could translate to an estimated 7–11% decrease in CVD risk [27]; however, given questions about HDL-C's causal role from Mendelian randomization studies [28], these estimates should be interpreted cautiously.”
Influential
- Authors
- Kunutsor, S. K., Zaccardi, F., Karppi, J., Kurl, S., & Laukkanen, J. A.
- Affiliations
- Southmead Hospital (GB)
- University of Leicester (GB)
- University of Eastern Finland (FI)
- Corresponding author
- Laukkanen, Jari A.
- Venue
- Journal of Atherosclerosis and Thrombosis
- Publisher
- Japan Atherosclerosis Society
- Published
- 2017
- Volume
- 24
- Issue
- 6
- Pages
- 600-608
- ISSN
- 1340-3478 (ISSN-L)
- 1880-3873
- PMC
- PMC5453685
- OpenAlex
- W2533010365
- Cited by
- 109
- References
- 53
- Citations by year
- 2026: 7 · 2025: 8 · 2024: 9 · 2023: 15 · 2022: 22 · 2021: 19 · 2020: 18 · 2019: 6 · 2018: 4 · 2017: 1
- FWCI
- 4.06
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- cc-by-nc-sa
- Locations
- Journal of Atherosclerosis and Thrombosis (publishedVersion, cc-by-nc-sa)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-sa)
- PubMed Central (publishedVersion, cc-by-nc-sa)
- PubMed (publishedVersion)
- UEF eRepo (University of Eastern Finland) (submittedVersion, cc-by-nc-sa)
- Bristol Research (University of Bristol) (submittedVersion, cc-by-nc-sa)
- Figshare (submittedVersion, cc-by-nc-sa)
- Leicester Research Archive (University of Leicester) (submittedVersion, cc-by-nc-sa)
- Funders
- Itä-Suomen Yliopisto
- Suomen Lääketieteen Säätiö
- Academy of Finland
- Suomen Kulttuurirahasto
- Jane ja Aatos Erkon Säätiö
- Topics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Epidemiology › Healthcare Systems and Public Health
- Keywords
- LDL/HDL ratio, sudden cardiac death, LDL cholesterol, HDL cholesterol, serum lipoproteins, cardiovascular risk factors, middle-aged men, ischemic heart disease
- MeSH terms
- Adult, C-Reactive Protein, Coronary Disease, Follow-Up Studies, Humans, Lipoproteins, Cholesterol, HDL, Cholesterol, LDL, Male, Middle Aged, Myocardial Infarction, Prospective Studies, Risk Factors, Rural Population, Urban Population, Body Mass Index, Proportional Hazards Models, Death, Sudden, Cardiac, Myocardial Ischemia
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