When evaluating a patient’s risk of vascular disease, primary-care clinicians often use the cholesterol/HDL ratio, while cardiologists use the LDL level. What should one do if the cholesterol/HDL ratio is favorable, but the LDL is high?
—Melvin L. Edwards, MD, Ann Arbor, Mich.

The usual reason the ratio is favorable is that the HDL is high. A high HDL has been thought to counteract the harmful effects of a high LDL, but this is undergoing revision (Am Heart J. 2004;147:966-976). Cardiologists weigh both levels in deciding whether drug therapy is needed. For example, an asymptomatic female with an LDL of 150 and an HDL of 90 is currently not considered at high risk, while a male with an LDL of 150 and an HDL of 35 is. The trend is definitely toward more emphasis on LDL levels, however.
—Peter F. Cohn, MD (117-4)

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