**6. References**


Cholesterol), which may include a variation that can reach 25% (Schectman & Sasse, 1993), with a potential and quite significant impact in the LDL-Cholesterol/HDL-Cholesterol ratio, eventually under-estimated. By contrast, the two components included in the Total-Cholesterol/HDL-Cholesterol ratio are measured directly. Supporting the superiority of these ratios over the isolated lipid parameters, is their unique ability to reflect the bidirectional cholesterol traffic (in and outward) through the arterial intima in a way that the individual LDL and HDL-Cholesterol levels cannot reach (Kannel, 2005). Consistent with this assumption, another recent cohort prospective study, involving over 15.000 women followed over a period of 10 years, demonstrated that the Total-Cholesterol/HDL-Cholesterol ratio alongside the non-HDL Cholesterol were predictors of future cardiovascular events, as good or better than apolipoprotein fractions (Ridker, Rifai, Cook *et* 

Of course, there are still unresolved issues, such as the definition of a cut-off in these ratios from which lipid-lowering therapy should be considered. The current guidelines of the NCEP (2001) recommend a cut-off of 2.5 for the ratio LDL-cholesterol/HDL-cholesterol. However, recent studies suggest that the risk of cardiovascular events begins to have significant expression for values between 3.3-3.7 (Cullen, Assmann & Schulte, 1997), in line

Given all the data currently available, as long as the fundamental reservations to the routine use of apolipoproteins are not exceeded, the use of lipid ratios in clinical practice is strongly advised, both in risk stratification and therapeutic decision and in monitoring its

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from coronary heart disease, 1980-1990: the effect of secular trends in risk factors


**15** 

**Dyslipidemia and Cardiovascular Disease** 

Four non-communicable diseases (NCDs) including cardiovascular disease (CVD), cancer, chronic respiratory disease, and diabetes were announced by World Health Organization (WHO) as the major causes of mortality in the world in 2008(Alwan, 2008). According to WHO prediction, in the next 10 years, mortality rate caused by NCDs will increase by 17 percent with the highest mortality rate in the regions of Africa (27 percent) and Eastern Mediterranean (EMRO, 25 percent) (Alwan, 2008). Fortunately more than 80 percent of heart disease, stroke, and type 2 diabetes mellitus incidence and almost one third of cancers could be prevented with appropriate interventions to reduce the effect of risk factors (Alwan,

Dyslipidemia, as a risk factor of CVD, is manifested by elevation or attenuation of plasma concentration of lipoproteins. Several methods have been used to classify the lipoproteins in respect to their density, physical, and chemical properties. Based on these classifications, different types of lipoproteins, including chylomicrones, IDL1, VLDL2, LDL3, and HDL4, and apolipoproteins (Apo), including Apo A, Apo B, Apo C, and Apo E, have been introduced. Generally, dyslipidemia is defined as the total cholesterol, LDL, triglycerides, apo B or Lp (a) levels above the 90th percentile or HDL and apo A levels below the 10th percentile of the

CVD is the most common health problem worldwide. This disease is often manifested as coronary heart disease (CHD). According to the international reports, mortality of CHD in the developed countries is expected to reach almost 29 percent in women and 48 percent in men in years 1990-2020. These figures have been estimated to increase by 120 percent in

Atherosclerosis is the most common cause of CHD. According to recent epidemiological studies, hypercholesterolemia and possibly coronary atherosclerosis are suggested as the sole risk factors of ischemic stroke. The results of a meta-analysis of 10 large cohort studies (Law et al., 1994) showed that for each 0.6 mmol/l reduction in serum cholesterol levels in

women and 137 percent in men (Thom et al., 1998) in the developing countries.

**1. Introduction** 

general population (Dobsn et al., 1996).

 Intermediate Density Lipoprotein Very Low Density Lipoprotein Low Density Lipoprotein High Density lipoprotein

2008).

Hossein Fakhrzadeh and Ozra Tabatabaei-Malazy

*Endocrinology & Metabolism Research Center, Tehran University of Medical Sciences,Tehran,* 

*Islamic Republic of Iran* 

