Coronary Plaque Volumes, HDL Cholesterol, and Total Cholesterol to HDL Ratio

Clogged arteries. arterial plaque
Clogged arteries. arterial plaque. Medical background. 3d illustration
Researchers assessed the relationship between coronary artery plaque burden and HDL-C level and total cholesterol to HDL ratio.

Outside of regular atherosclerosis risk factors, there is a significant association between low HDL cholesterol (HDL-C) and a rising total cholesterol to HDL (TC/HDL) ratio with increasing coronary plaque volumes, according to research presented at the National Lipid Association Scientific Sessions, from June 2nd through 5th, in Scottsdale, AZ.

Previous studies have shown HDL-C levels and the TC/HDL ratio are useful predictors of cardiovascular risk, but not how or why that is. Researchers sought to examine the association between HDL-C level and the TC/HDL ratio with coronary artery plaque volumes.

To accomplish this, they conducted a cross-sectional study that included 190 participants (aged 58.9±9.8 years; 37% women; 83% had hypertension; 78% had hyperlipidemia; 57% had diabetes) with stable coronary artery disease who participated in quantitative plaque analysis and lipoprotein level analysis. Evaluation of the association of HDL-C and TC/HDL ratio with coronary plaque volumes was achieved with multivariate regression models adjusted for cardiovascular risk aspects.

HDL-C (>40 mg/dl) is inversely associated with fibrous plaque (P =.003), fibrous fatty plaque (P =.009), low attenuation plaque (LAP) (P =.014), total noncalcified plaque (TNCP) (P =.003) and total plaque (TP)(P =.005) volume, but is not associated with dense calcified plaque (P =.229), after adjustment for cardiovascular risk factors.

The TC/HDL ratio (>4.0) is associated with LAP (P =.024), but statistically not associated with the fibrous, fibrofatty, TNCP, and TP volumes.

“There is a strong association between low HDL-C and increasing TC/HDL ratio with increasing coronary plaque volumes, independent of traditional risk factors of atherosclerosis,” the study authors noted. “The findings of this study suggest mechanistic evidence supporting the protective role of HDL-C in coronary artery disease.”


Manubolu VS, Verghese D, Alalawi L, et al. Coronary computed tomography angiography evaluation of plaque morphology and its relationship to HDL and total cholesterol to HDL ration. Presented at: National Lipid Association Scientific Sessions; June 2-5, 2022; Scottsdale, AZ. Abstract #67.