Don't be fooled by RATIOS like Triglycerides:HDL-C | Summary and Q&A

TL;DR

Ratios like total cholesterol over HDL-cholesterol or triglycerides over HDL-cholesterol correlate with cardiovascular disease in population studies, but they are markers of risk rather than direct causes.

Key Insights

• 🧬 Metrics like total cholesterol, HDL-cholesterol, and triglycerides are markers of risk for heart disease but do not directly cause risk.
• 💉 Factors like glucose level, smoking, ApoB, and blood pressure directly modulate the risk of heart disease.
• 🔬 HDL-cholesterol, despite correlating with a lower risk of heart disease in population studies, does not lower risk per se.
• 💼 The use of ratios like total cholesterol to HDL-cholesterol can be misleading as these markers can change without affecting risk.
• 🚬 Carrying a lighter with us correlates with disease risk but does not cause disease, highlighting the limitations of using certain metrics as predictors.
• 📊 Combining imperfect markers through ratios can provide better predictors of disease risk at a population level but may not be reliable for individual assessment.
• 🍷 High ApoB levels should not be ignored or dismissed based on ratios, as ratios do not replace causal factors like glucose, blood pressure, and smoking.
• 💡 ApoA-I ratios, similar to other ratios examined, are not reliable indicators of risk as they do not appear to be causal factors for heart disease.

Transcript

are ratios like total cholesterol over  HDL-cholesterol or triglycerides over   HDL-cholesterol the best measure of our risk of  heart disease? we've talked about these ratios   several times in the past but  this is such a common question,   it comes up almost daily in the comments,  that I thought it deserved its own video. it's   widely known th... Read More

Questions & Answers

Q: Do ratios like total cholesterol over HDL-cholesterol or triglycerides over HDL-cholesterol directly cause heart disease?

No, these ratios are markers of risk rather than direct causes of heart disease. They correlate with risk but don't actually cause it, as supported by evidence from randomized controlled trials and genetic data.

Q: Are higher levels of HDL-cholesterol protective against heart disease?

No, higher levels of HDL-cholesterol do not lower the risk of heart disease. HDL-cholesterol is a marker of other factors such as obesity, diabetes, liver disease, and smoking, but it is not protective on its own.

Q: Why do ratios like total cholesterol over HDL-cholesterol correlate well with risk in population studies?

Ratios combining markers like triglycerides and HDL-cholesterol can be good predictors of heart disease risk in population studies because they capture multiple risk factors. However, they may not be reliable on an individual level.

Q: Can positive changes like weight loss improve ratios and lower heart disease risk?

Positive changes like weight loss can reflect on the ratios, making them look better. However, having a good ratio does not guarantee lower heart disease risk because the components of the ratio can change without risk necessarily changing as well.

Summary & Key Takeaways

• Ratios such as total cholesterol over HDL-cholesterol and triglycerides over HDL-cholesterol correlate with cardiovascular disease but are markers of risk, not actual causes.

• HDL-cholesterol, despite its correlation with lower heart disease risk in population studies, is not protective when increased through genetics or medication.

• Factors that directly modulate heart disease risk include glucose levels, smoking, ApoB, and blood pressure, among others.