Keele Research Repository

Total cholesterol to high density lipoprotein cholesterol ratio (TC/HDL) is an important prognostic factor for cardiovascular disease (CVD). This study used restricted cubic spline modelling to investigate the dose-response associations between TC/HDL and both CVD hospitalisation and CVD re-hospitalisation in two independent prospective cohorts. The East Cambridgeshire and Fenland (ECF) cohort includes 4,704 patients with type 2 diabetes from 18 general practices in Cambridgeshire. The RAndomised controlled trial of Peer Support In type 2 Diabetes (RAPSID) cohort comprises 1,121 patients with type 2 diabetes with post-trial follow-up data. TC/HDL and other demographic and clinical measurements were measured at baseline. Outcomes were CVD hospitalisation over 2 years, and CVD re-hospitalisation after 90 days of the prior CVD hospitalisation. Modelling showed nonlinear relationships between TC/HDL and risks of CVD hospitalisation and re-hospitalisation consistently in both cohorts (all P < 0.001 for linear tests). The lowest risks of CVD hospitalisation and re-hospitalisation were consistently found for TC/HDL at 2.8 (95% confidence interval: 2.6 to 3.0) in both cohorts and both overall and by gender. This is lower than the current lipid control target, 4.0 of TC/HDL. Reducing the TC/HDL target to 2.8 would include a further 33-44% patients with TC/HDL in the 2.8-4.0 range. Studies are required to assess the effectiveness and cost effectiveness of the earlier introduction of, and more intensive, lipid lowering treatment needed to achieve this new lower TC/HDL target.