Evidence map›Paper›PMID 31291776›Full record

ArticleEuropean journal of preventive cardiology2020

Total cholesterol/HDL-cholesterol ratio discordance with LDL-cholesterol and non-HDL-cholesterol and incidence of atherosclerotic cardiovascular disease in primary prevention: The ARIC study.

Renato Quispe, Mohamed B Elshazly, Di Zhao, Peter P Toth, Rishi Puri, Salim S Virani, Roger S Blumenthal, Seth S Martin, Steven R Jones, Erin D Michos

Open access · greenAbstract readMulticenter Study
In one paragraph

Article in European journal of preventive cardiology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 59 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
59citing papers in PubMed, 1 pooled it
6.6field-weighted citation impact, top 3% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

59 citing papers in PubMed, 1 synthesis or guideline pooled it, 98 citations in OpenAlex.

  1. Pooled it
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  13. Poor olfaction and risk of heart failure in the Atherosclerosis Risk in Communities Study.The journals of gerontology. Series A, Biological sciences and medical sciences · 2025
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 4 institutions in 2 countries.

Renato QuispeCiccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, USA.
Mohamed B ElshazlyCiccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, USA.
Di ZhaoDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, USA.
Peter P TothCiccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, USA.
Rishi PuriDepartment of Cardiovascular Medicine, Cleveland Clinic, USA.
Salim S ViraniMichael E DeBakey Veterans Affairs Medical Center and Section of Cardiovascular Research, Baylor College of Medicine, USA.
Roger S BlumenthalCiccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, USA.
Seth S MartinCiccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, USA.
Steven R JonesCiccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, USA.
Erin D MichosCiccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, USA.
Johns Hopkins University · USJohns Hopkins Medicine · USCleveland Clinic · USMichael E. DeBakey VA Medical Center · US

Funding

NHLBI NIH HHS HHSN268201700001CNHLBI NIH HHS HHSN268201700001INHLBI NIH HHS HHSN268201700002CNHLBI NIH HHS HHSN268201700002INHLBI NIH HHS HHSN268201700003CNHLBI NIH HHS HHSN268201700003INHLBI NIH HHS HHSN268201700004CNHLBI NIH HHS HHSN268201700004INHLBI NIH HHS HHSN268201700005CNHLBI NIH HHS HHSN268201700005I
6 · The paper itself

Abstract

aimsThe total cholesterol (TC)/high-density lipoprotein (HDL) cholesterol ratio may carry additional information not available in more commonly used single cholesterol measures. Analysis of discordance between lipid parameters might help assess the impact of such additional information on the risk of atherosclerotic cardiovascular disease. We aimed to investigate the role of the TC/HDL-cholesterol ratio in determining atherosclerotic cardiovascular disease risk when discordant with low-density lipoprotein (LDL) cholesterol and non-HDL-cholesterol.

methodsWe studied 14,403 Atherosclerosis Risk in Communities (ARIC) study participants who were free of atherosclerotic cardiovascular disease at baseline. TC/HDL-cholesterol discordance with LDL-cholesterol (estimated by the novel Martin/Hopkins method) and non-HDL-cholesterol was assessed at five visits and determined by being at or above the median for each lipid parameter. We constructed Cox proportional hazard models to estimate the risk for incident atherosclerotic cardiovascular disease events associated with each lipid concordance/discordance category using a time-varying approach.

resultsMean age of participants was 54.1 years, 56% women and 25% black. There were 2634 atherosclerotic cardiovascular disease events over a median (interquartile range) follow-up of 24.2 (16.0-25.4) years. Among individuals with LDL-cholesterol and non-HDL-cholesterol less than the median, 26% and 21% had discordant TC/HDL-cholesterol at or above the median, respectively. These individuals had a 24% (hazard ratio (HR) 1.24, 95% confidence interval (CI) 1.09, 1.41) and 29% (HR 1.29, 95% CI 1.13, 1.46) greater risk of incident atherosclerotic cardiovascular disease, respectively, compared to those with TC/HDL-cholesterol less than the median after multivariable adjustment. In individuals with diabetes with LDL-cholesterol or non-HDL-cholesterol less than the median, discordant TC/HDL-cholesterol at or above the median was more prevalent at 48% and 38%, respectively.

conclusionClinically significant discordance exists between TC/HDL-cholesterol, available from the standard lipid profile, and the routinely used non-HDL-cholesterol and LDL-cholesterol. Such discordance may help inform atherosclerotic cardiovascular disease risk management, particularly in individuals with diabetes in whom discordance is more common.

Indexed as

AtherosclerosisBiomarkersCardiovascular DiseasesCholesterolCholesterol, HDLCholesterol, LDLFemaleFollow-Up StudiesHumansIncidenceMaleMiddle AgedPrimary PreventionProspective StudiesRisk AssessmentRisk FactorsBiomarkersCholesterolCholesterol, HDLCholesterol, LDLcardiovascular riskHDL-cholesterolLDL-cholesterolnon-HDL-cholesterolprimary preventionTotal cholesterol

Identifiers

PMID31291776
PMCPMC6952589
OpenAlexW2959960193

What Socratic holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.