Joint Effects of Serum Triglyceride and LDL Cholesterol and HDL Cholesterol Concentrations

a dummy variable technique that allows simultaneous study of subgroup combinations from the placebo and treatment groups. Medwxs and Results. In the placebo group (n=2,045), the low density lipoprotein cholesterol (LDL-C)/high density lipoprotein cholesterol (HDL-C) ratio was the best single predictor ofcardiac events. This ratio in combination with the serum triglyceride level revealed a high-risk subgroup: subjects with LDL-C/HDL-C ratio >5 and triglycerides >2.3 mmol/1 had a RR of 3.8 (95% CI, 2.2-6.6) compared with those with LDL-C/HI)L-C ratio <5 and triglyceride concentration c2.3 mmol/1. In subjects with triglyceride concentration >2.3 mmoUll and LDL-C/H1)L-C ratio <5, RR was close to unity (1.1), whereas in those with triglyceride level s2.3 mmoVIl and LDL-C/HDL-C ratio >5, RR was 1.2. The high-risk group with LDL-C/HDL-C ratio >5 and triglyceride level >2.3 mmol/1 profited most from treatment with gemfibrozil, with a 71% lower incidence ofcoronary heart disease events than the corresponding placebo subgroup. In all other subgroups, the reduction in CHD incidence was substantially smaller. Conclusions. Serum triglyceride concentration has prognostic value, both for assessing coronary heart disease risk and in predicting the effect of gemfibrozil treatment, especially when used in combination with HDL-C and LDL-C. (Circulation 1992;85:37-45)