Establishment of an Association between HDL/LDL Ratio and 10-year Predicted Cardiovascular Risk Using ASCVD Risk Estimator

Abstract

Background: Cardiovascular disease (CVD) is a significant global public-health concern, as this is the most common cause of death worldwide. This refers to any disease that affects the heart/blood vessels which is frequently linked with atherosclerosis leading to cardiac events. The 10-year predicted risk for atherosclerotic cardiovascular disease (ASCVD_10), which can be obtained through the ASCVD risk estimator, used for the primary prevention of CVDs. The novel parameter, High-Density Lipoprotein/Low-Density Lipoprotein ratio (HDL/LDL_Ratio) is clinically being studied as an important predictor of CVD risk. Objectives: To establish of an association between HDL/LDL_Ratio and 10-year predicted cardiovascular risk using the ASCVD risk estimator Methods: A total of 65 volunteers between age 40-70 years without any previous history of CVD or cholesterol lowering drugs were selected. HDL/LDL_Ratio was enumerated through the manual lipid-profile analysis. The ASCVD_10 of each individual was calculated using “ASCVD Risk Estimator Plus-Mobile and Web Apps-American College of Cardiology”, admitting the details of the questionnaire. Statistical analysis was performed by SPSS version 26.0. The parameters were checked for their normality and the correlation bivariate analysis. The Receiver Operating Characteristic (ROC) curve analysis were performed, first Total-Cholesterol/High Density Lipoprotein (TC/HDL_Ratio) categorized in to two groups as TC/HDL_Ratio<4.5, TC/HDL_Ratio≥4.5 and a cut-off value for HDL/LDL was derived (0.32). Based on 0.32, second ROC-curve analysis was performed for the groups of HDL/LDL_Ratio (HDL/LDL_Ratio <0.32 and HDL/LDL_Ratio ≥0.32). Results: None of the parameters followed the normal distribution. So, the non-parametric Spearman correlation showed that they were significantly and negatively correlated with each other (r=-0.524; p<0.001). From the second ROC curve analysis, a cut-off value was derived for ASCVD_10 as 2.5% based on two groups of HDL/LDL_Ratio, with Area Under Curve 0.693, Sensitivity 76.0% and Specificity 56.0%. Conclusion: The ROC curve analysis results lead to predict the ASCVD_10 from conveniently available HDL/LDL_Ratio and this indicates, once the HDL/LDL_Ratio appears above 0.32, the ASCVD_10 present below 2.5%. These initial results can be uplifted by increasing the number of participants.