The study was conducted in a population of middle-aged and elderly Chinese, which was known to have a high prevalence of arterial stiffness. In previous study, we concluded that serum HDL-c had protective effect on arterial stiffness. As an extension of previous study, we investigated the clinical evaluation of the various lipid ratio profiles and had two major findings: 1) all the lipid profiles and lipid ratios, such as TC, TG, HDL-c, LDL-c, non-HDL-c, TC/HDL-c, LDL-c/HDL-c, and non-HDL-c/HDL-c, are significantly correlated with arterial stiffness assessing by baPWV, and 2) Individuals with higher non-HDL-c/HDL-c levels have higher risk of arterial stiffness than other lipid parameters.
CVD represents a major cause of morbidity and mortality worldwide . Arterial stiffness is an important determinant of cardiovascular risk [19, 20]. Patients with hypercholesterolaemia have higher stiff blood vessels than matched controls, which have similar peripheral blood pressures . Earlier studies had indicated that lipids and the related ratios were strong predictors of CVD. Some lipids had been the main target for clinical intervention of CVD [22–25]. Most previous studies focused on only one ratio or traditional lipids [8–10]. There is no study that evaluated the relationship between all the lipids and lipid ratios with arterial stiffness. In the present study, we evaluated the relationship between the lipids and the ratios with baPWV, and highlighted the rationale for using the lipid ratio of non-HDL-c/HDL-c as a risk factor for arterial stiffness risk in middle-aged and elderly Chinese.
In the study, HDL-c and all the lipid ratios were significantly correlated with the baPWV tertiles in the overall patients. Only HDL-c, TC/HDL-c, and non-HDL-c/HDL-c worked in both the male and female population. All the conventional lipids and the ratios had a significant correlation with baPWV in the overall population. Only HDL-c and the lipid ratios worked in both the male and female population. Finally, in the multivariate logistic regression analysis after adjusting for age and gender, only non-HDL-c/HDL-c and HDL-c had significant estimating capacities. Non-HDL-c/LDL-c seemed to be superior to HDL-c in assessing the risk for arterial stiffness. Non-HDL-c/HDL-c, an easily obtained index, maybe offer convenience in screening large populations of arterial stiffness risk in routine clinical practice.
The pathophysiology of non-HDL-c/HDL-c with arterial stiffness is unclear, but data from literatures is helpful. Non-HDL-c is a measurement of the cholesterol in LDL and VLDL (intermediate-density lipoprotein and very-LDL) particles. In clinical practice, non-HDL-c had been recommended as a secondary therapeutic target in individuals with high TG concentration. It also had been reported to be a better predictor of CVD than LDL-c . The non-HDL-c/HDL-c is a lineal combination of TG and HDL-c. In the last few years, the focus had been shifted towards non-HDL-c/HDL-c. A report from the Swedish National Diabetes Register demonstrated that non-HDL-c/HDL-c had a stronger relationship with coronary heart disease risk than LDL-c, HDL-c and non-HDL-c. A recent study found that non-HDL-c/HDL-c was a better indicator than apolipoprotein B (ApoB)/apolipoprotein A1 (ApoA1) and ApoB/LDL-c in identifying MetS and insulin resistance [27, 28]. However, few studies had evaluated the relationship between non-HDL-c/HDL-c ratio and arterial stiffness.
The study compared the association between the routine lipids and the related ratios with baPWV for the first time. However, the study has some limitations. First, the experimental population was modest in size, and entirely of Chinese origin, which may be limited in the generalizability of the results. Second, since the study was cross-sectional designed, no causal relationship between lipid profiles and the risk of arterial stiffness can be drawn. Thus, we hope the findings can stimulate more investigators.
In conclusion, the study provides the novel findings that all the lipids and the ratios are significantly correlated with baPWV. Non-HDL-c/HDL-c ratio performs more effectively in identifying individuals at increased arterial stiffness risk. As non-HDL-c/HDL-c is easy and cost-effective obtained, it seems reasonable to propose non-HDL-c/HDL-c as a surrogate indicator of arterial stiffness in clinical practice.