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Which is a better health predictor, HDL or LDL?

by (2611) Updated December 27, 2013 at 2:09 PM Created December 06, 2013 at 2:03 AM

I am helping coordinate a health testing event at which we're doing free cholesterol measurements for visitors. The problem is, those cholesterol test strips are *expensive*. We can probably afford to measure HDL, LDL, *or* total cholesterol, but only one of the three. It's not a fasting test, so triglycerides are out.

I know total cholesterol is pretty worthless, but would you recommend HDL or LDL? I'm looking for empirical findings demonstrating which is a better predictor of cardiovascular disease or death.

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10077 · December 06, 2013 at 3:37 AM

This predictor for CV health shows a strong positive effect from raising HDL and a weak negative effect from raising TC.

http://cvdrisk.nhlbi.nih.gov/calculator.asp

In tweaking this model I found that the negative effect of LDL in raising TC was not nearly as important as getting to higher HDL.

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10077 · December 26, 2013 at 9:42 PM

Rather than add this as an edit or a comment, there's been a lot of commotion in both the media and medical community lately about using the Pooled Cohort Equations to predict CV and stroke risk:

http://clincalc.com/Cardiology/ASCVD/PooledCohort.aspx

This is the Framingham study methodology updated for race and stroke risk. It downplays LDL, suggesting that it's not a major risk within a wide band (70-190 mg/dL). The ruckus is partly about this change, and partly about the insistence that statins are still important even though their major effect is lowering LDL.

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188 · December 06, 2013 at 4:01 AM

I think you are just doing a disservice to people by offering them a free small part of a total picture that is still fuzzy at best. What do you hope to accomplish? Are we in 2013 any better off than before anyone knew what HDL/LDL meant?

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