Date sent: Thu, 31 Jan 2002 13:56:44 +0000
Send reply to: Lance Sandle <[log in to unmask]>
From: Lance Sandle <[log in to unmask]>
Subject: Total to HDL cholesterol ratio
To: [log in to unmask]
You have brought up two independent issues:
1. The provision of the ratio
2. Tha ideal range or reference range
1. The SIGN guidelines for the primary prevention of CHD (No. 40)
state that all labs in Scotland should provide the ratio in their
reports. This obviously avoids potential mistakes with the division
and I believe that it is the least that laboratories can due to help the
health service address this public health issue. The validity of the
ratio derives from the Framingham heart study and the subsequent
Offspring study amongst others.
2. Like you, I have seen ranges in the literature of <4.0, <4.5 and
<5.0. Which should be employed by laboratories and the
subsequent action by clinicians is less clear. I can't recall any
specific guidelines from the BHA, BHS, BCS or Diabetes UK. The
important issue seems to be the overall CHD risk.
Our laboratory provides the ratio but has not provided a range i.e.
we have addressed the former while side stepping the later.
Pat
Dear Colleagues
Total:HDL ratio appears on various risk prediction
charts and in the literature. Though not at present
under pressure to provide this derived parameter on
lab reports, I would have to be confident that it has
been validated before doing so. Obviously I'm happy to
report total and HDL cholesterol, leaving those still
capable of long division to work out the ratio for
themselves. What I'm not happy to do is take
responsibility for a derived result of dubious
scientific provenance.
I've seen cut-off values of 4.0 and 4.5 quoted -
sometimes by the same author, hence my scepticism!
Has anyone got hard evidence of its validity?
=====
Dr Lance N Sandle
Consultant Chemical Pathologist
Department of Chemical Pathology
Trafford General Hospital, Moorside Road, Davyhulme
Manchester M41 5SL United Kingdom
Tel: +44(0)161 746 2473 Fax: +44(0)161 746 8545
e-mail: [log in to unmask]
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tel: 0131-5362704
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