Is High Serum LDL/HDL Cholesterol Ratio an Emerging Risk Factor for Sudden Cardiac Death? Findings From the KIHD Study

Setor Kunutsor, Francesco Zaccardi, Jouni Karppi, Sudhir Kurl, Jari Laukkanen

Research output: Contribution to journalArticle (Academic Journal)peer-review

24 Citations (Scopus)
171 Downloads (Pure)


Aim: Low-density lipoprotein cholesterol (LDL-c) and high-density lipoprotein cholesterol (HDL-c), which are components of total cholesterol, have each been suggested to be linked to the risk of sudden cardiac death (SCD). However, the relationship between LDL-c/HDL-c ratio and the risk of SCD has not been previously investigated. We aimed to assess the associations of LDL-c, HDL-c, and the ratio of LDL-c/HDL-c with the risk of SCD.

Methods: Serum lipoprotein concentrations were assessed at baseline in the Finnish Kuopio Ischemic Heart Disease prospective cohort study of 2,616 men aged 42–61 years at recruitment. Hazard ratios (HRs) (95% confidence intervals [CI]) were assessed.

Results: During a median follow-up of 23.0 years, a total of 228 SCDs occurred. There was no significant evidence of an association of LDL-c or HDL-c with the risk of SCD. In analyses adjusted for age, examination year, body mass index, systolic blood pressure, smoking, alcohol consumption, physical activity, years of education, diabetes, previous myocardial infarction, family history of coronary heart disease, and serum high sensitivity C-reactive protein, there was approximately a two-fold increase in the risk of SCD (HR 1.94, 95% CI 1.21–3.11; p=0.006), comparing the top (>4.22) versus bottom (≤2.30) quintile of serum LDL-c/HDL-c ratio.

Conclusion: In this middle-aged male population, LDL-c or HDL-c was not associated with the risk of SCD. However, a high serum LDL-c/HDL-c ratio was found to be independently associated with an increased risk of SCD. Further research is warranted to understand the mechanistic pathways underlying this association.
Original languageEnglish
Pages (from-to)1-9
Number of pages9
JournalJournal of Atherosclerosis and Thrombosis
Publication statusPublished - 26 Oct 2016


  • Low-density lipoprotein cholesterol
  • High-density lipoprotein cholesterol
  • Sudden cardiac death

Fingerprint Dive into the research topics of 'Is High Serum LDL/HDL Cholesterol Ratio an Emerging Risk Factor for Sudden Cardiac Death? Findings From the KIHD Study'. Together they form a unique fingerprint.

Cite this