Bret Scher, MD - Figure 42
Hazard ratios for development of coronary heart disease
This next slide is an important part of the discussion of metabolic health and LDL cholesterol. You don't necessarily have to choose between them; what this study shows is how you would rank their importance in terms of predicting future cardiovascular risk. So this was from the women's health study, which included 21 years of follow-up. In the beginning of the study, they did extensive evaluations: Who has type 2 diabetes, metabolic syndrome, elevated LDL cholesterol, elevated apo B, et cetera. Then they asked, how well did each variable predict the risk of developing cardiovascular disease? And, LDL is there at 1.38, so close to 1.4 in terms of the hazard ratio or the increased risk. Apo B, again, is a bit better of a predictor at almost 1.9. But look at the lipoprotein insulin resistance score. So looking at the lipoproteins that are most consistent with metabolic dysfunction and insulin resistance is much more predictive at 6.4. This correlates well, when you go up to the top section there and see metabolic syndrome with a hazard ratio of 6.0 and then type 2 diabetes at 10. When you look at a study like this, if you had to choose whether you want to improve someone's metabolic health or lower their LDL, this certainly suggests that metabolic health is the bigger rock – so to speak – the more important priority that's going to impact cardiovascular risk more.