Lipid Profile In Pregnancy Research Articles

Study of Serum Lipid Profile in Pregnancy and its Association with Pre-Eclampsia

Study of Serum Lipid Profile in Pregnancy and its Association with Pre-Eclampsia

Maternal lipid profile in pregnancy and embryonic size: a population-based prospective cohort study

BackgroundLipids are crucial for fetal growth and development. Maternal lipid concentrations are associated with fetal growth in the second and third trimester of pregnancy and with birth outcomes. However, it is unknown if this association starts early in pregnancy or arises later during fetal development. The aim of this study was to investigate the association between the maternal lipid profile in early pregnancy and embryonic size.MethodsWe included 1474 women from the Generation R Study, a population based prospective birth cohort. Both embryonic size and the maternal lipid profile were measured between 10 weeks + 1 day and 13 weeks + 6 days gestational age. The maternal lipid profile was defined as total cholesterol, triglycerides (TG), high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c), remnant cholesterol, non-high-density (non-HDL-c) lipoprotein cholesterol concentrations and the triglycerides/high-density lipoprotein (TG/HDL-c) ratio. Additionally, maternal glucose concentrations were assessed. Embryonic size was assessed using crown-rump length (CRL) measurements. Associations were studied with linear regression models, adjusted for confounding factors: maternal age, pre-pregnancy body mass index (BMI), parity, educational level, ethnicity, smoking and folic acid supplement use.ResultsTriglycerides and remnant cholesterol concentrations are positively associated with embryonic size (fully adjusted models, 0.17 SDS CRL: 95% CI 0.03; 0.30, and 0.17 SDS: 95% CI 0.04; 0.31 per 1 MoM increase, respectively). These associations were not present in women with normal weight (triglycerides and remnant cholesterol: fully adjusted model, 0.44 SDS: 95% CI 0.15; 0.72). Associations between maternal lipid concentrations and embryonic size were not attenuated after adjustment for glucose concentrations. Total cholesterol, HDL-c, LDL-c, non-HDL-c concentrations and the TG/HDL-c ratio were not associated with embryonic size.ConclusionsHigher triglycerides and remnant cholesterol concentrations in early pregnancy are associated with increased embryonic size, most notably in overweight women.Trial registrationThe study protocol has been approved by the Medical Ethics Committee of the Erasmus University Medical Centre (Erasmus MC), Rotterdam (MEC-2007-413). Written informed consent was obtained from all participants.

Evaluation of Lipid Profile in Pregnancy and Patients with Gestational Diabetes Mellitus in North Indian Population

Background: Significant alterations in maternal lipid metabolism occur during pregnancy. gestational diabetes mellitus (GDM) is the most commonly seen metabolic disorder during pregnancy. The association between dyslipidemia and GDM is unclear. Methods: The study population was from pregnant women attending the antenatal clinic of Department of Obstetrics and Gynecology, Lok Nayak Hospital, Delhi. Ethical clearance was granted by the ethical committee of the institute. Patients who attended the clinic at or before 28 weeks of gestation and were willing to participate were included in the study and venous sample was taken for lipid profile in fasting state. Lipid levels were compared in GDM and non GDM patients. Findings: Total 936 patients were recruited in the study and out of these 64 patients were diagnosed as GDM. The mean values of total serum cholesterol, triglyceride (TG) and high-density lipoprotein (HDL) cholesterol were 194.89+35.96 mg/dl, 170.96+46.69 mg/dl and 50.1+7.16 mg/dl respectively in all pregnant patients. The levels of total serum cholesterol and triglycerides were significantly higher in patients with GDM than in patients without GDM (p<0.001), whereas the difference in HDL cholesterol was not significant between two groups. Interpretation: Triglyceride levels are raised in all pregnant patients. Total cholesterol and triglyceride levels a significantly raised in GDM patients in comparison to non GDM patients.

Evaluation of Lipid Profile in Pregnancy and Patients with Gestational Diabetes Mellitus in North Indian Population

Evaluation of Lipid Profile in Pregnancy and Patients with Gestational Diabetes Mellitus in North Indian Population

A study of Thyroid Function test and Lipid Profile in Pregnancy

Pregnancy is known to create profound changes in the body. It causes hormonal changes in the bodywhich may lead to changes in lipid profile. TSH levels are usually suppressed due to very high levelsof Human chorionic gonadotropin (hCG) during the first half of the pregnancy. Thyroid dysfunction mayresult in various changes in triglycerides, phospholipids, cholesterol and other lipoproteins. Dyslipidemia, aconsequence of thyroid dysfunction, generally increases the risk for cardiovascular disease.The study was conducted in the Department of Biochemistry, MMC&RI, Mysore. 100 women with asingleton pregnancy irrespective of parity and gravida were enrolled and cases like chronic hypertension,Diabetes mellitus, Renal Disorders and Thyroid Disorders, Obstetric and Foetal Complications (Hydropsfoetalis, congenital foetal anomalies) were excluded from the study. Blood was analysed for thyroid andlipid profile.Conclusion: T3, T4 and TSH levels are within normal range during pregnancy. There is a positive correlationbetween TSH levels and cholesterol. This suggest that regular TSH and cholesterol estimation is veryimportant during pregnancy to reduce the maternal and fetal complications.

Evaluation and Comparison of Lipid Profile in Pregnancy and Preeclampsia

Objective: The objective of the study is to evaluate and compare the lipid profile in normotensive pregnancy and in pre-eclamptic pregnant women.Methods: The study was a case-control study, conducted from January 2018 to June 2018. The sample size was 90. Participants were recruited after fulfilling the selection criteria out of which, 45 were normal pregnant females and 45 were pregnant females with Preeclampsia (PE). Participants were placed in two groups namely A and B. Group A were 45 healthy pregnant females and group B were 45 preeclamptic pregnant women. The biophysical parameters included age, weight, height and BMI. Blood pressure was recorded through standard protocols. Blood was taken for lipid profile which includes Cholesterol, Triglyceride and HDL-C, measured through enzymatic colourimetric (CHOD-PAP) method, Glycerol-3-Phosphate Oxidase Phenol Aminophenanzone (GPO-PAP) method and Cholesterol Oxidase-Phenol Aminophenazone (CHOD-PAP) method respectively, however; LDL-cholesterol was calculated through Friedewald's formula. Urinary protein was measured through URS Strips through semi-automated analyser CYBOW reader 300. Data were statistically analysed through IBMSPSS software version 20 with the help of one-way analysis of variance (ANOVA) analysis, Tukey'sHSD test, independent sample t-test and Pearson correlation analysis by considering p-values 0.05 as a significant.Results: The results of the study revealed a significant rise in the lipid profile of pregnant women with preeclampsia than in normotensive pregnant women including cholesterol, Triglyceride, HDL-C and LDL-C.Conclusion: The study concluded that dyslipidaemia or hyperlipidaemia in early pregnancy could be one of the reasons for developing preeclampsia in late pregnancy and the risk of being hypertensive in advanced age.

Study of serum lipid profile in pregnancy and its correlation with preeclampsia

Objective: To study serum lipid profile between 13-20 week of pregnancy & to look for correlation, if any, of serum lipid levels in pregnancy with preeclampsia and to find out correlation, if any, between serum lipids profile and fetomaternal outcome. Material and methods: We carried out a Longitudinal, Descriptive type of observational study in the department of Obstetrics and Gynecology at SDMH, Jaipur from June 2016 to April 2017.Total 125 patients were enrolled in study fulfilling inclusion and exclusion criteria between 13-20 weeks of gestation at SDMH, Jaipur, 14 patients were lost during follow up finally 111 patients remained for analysis .Serum lipid profile was done in all patients and these were followed till delivery for presence and absence of preeclampsia. Results: The mean level of TC in participants developed preeclampsia was 224.36±43.68mg/dl. This was significantly higher as compared to normotensive group 180.77±36.58mg/dl. Conclusion: Early prediction of preeclampsia can be used as a tool for primary prevention before the development of the disease. There is no single specific test available to predict the preeclampsia till date. So there is need of further research to discover the specific test to predict preeclampsia

Pattern of Lipid Profile in Pregnancy and its Impact on the Gestational Course

Background: Major changes in lipid profile occur during normal pregnancy with significant correlation could be detected with gestational complications. Objective: We aimed to screen lipid profile in a sample of Egyptian pregnant and assess the correlation between second trimester maternal lipid profile and gestational outcome. Methods: This cohort study included 94 women with maternal lipid profile assessed during the second trimester (16-18 weeks). Serial antenatal visits were conducted to record the development of maternal gestational hypertension, preeclampsia, gestational diabetes mellitus and low birth weight. Results and discussion: Lipid profile components in pregnant is higher than normal references. Meanwhile, gestational hypertension (GH) was the most common complication in the study affecting 13 patients (13.8%) followed by preeclampsia (PE) in 8 patients (8.5%), gestational DM (GDM) in 7 patients (7.4%) and lastly low birth weight in 4 neonates (4.3%). Positive association between second trimester lipid profile components and GH, PE and GDM was found. Conclusion: Measurement of lipid profile during the second trimester is highly recommended and could be a useful predictor of hypertensive disorders and GDM among Egyptian women.

Fasting lipid profile in pregnancy associated hypertensive disorders

Fasting lipid profile in pregnancy associated hypertensive disorders

30. Maternal lipid profile in early pregnancy and the link with blood pressure and pregnancy complications

Introduction An atherogenic lipid profile is a risk factor for atherosclerosis and consequently for stroke and cardiovascular disease (CVD). An atherogenic lipid profile can cause endothelial dysfunction and consequently higher blood pressure (BP). Placentas of women with a gestational hypertensive disorder (GHD) are histologically comparable to an early stage of atherosclerosis. Objective To determine the association between maternal lipid profile in early pregnancy, GHD and BP throughout pregnancy and six and nine years after pregnancy. Methods We included 5692 women from The Generation R Study; an ongoing population-based prospective birth cohort. 218 (4.1%) women developed gestational hypertension (GH) and 139 (2.6%) women developed pre-eclampsia (PE). Maternal lipid levels included total-cholesterol, triglycerides and HDL-c, and were measured in early pregnancy (median 13.4 weeks of gestation). LDL-c, remnant cholesterol and non-HDL-c were calculated. Systolic and diastolic BP were measured in early, mid- and late pregnancy, and six and nine years after pregnancy. Results In the total population, total-cholesterol, triglycerides, LDL-c, remnant cholesterol and non-HDL-c were positively associated with BP in early, mid- and late pregnancy, six and nine years after pregnancy. Women with PE had higher levels of triglycerides and remnant cholesterol in early pregnancy compared to those with a normotensive pregnancy. Maternal lipid levels in early pregnancy were not associated with GH. Discussion An atherogenic lipid profile in pregnancy is positively associated with BP throughout pregnancy, and six and nine years after pregnancy. In particular triglycerides are important for the risk for PE. Lipid levels in early pregnancy might help to identify women at risk for not only PE, but also future hypertension and consequently initiate early prevention of future CVD.

Associations between the maternal circulating lipid profile in pregnancy and fetal imprinted gene alleles: a cohort study

BackgroundImprinted genes, which are expressed in a parent of origin-specific manner, are thought to mediate the genetic priorities of each parent in pregnancy. Recently we reported that some fetal imprinted gene variants are associated with maternal glucose concentrations and blood pressures in pregnancy. We suggest that the conflict between the effects of paternal and maternal transmitted genes starts at conception and may already be evident in measures of maternal metabolism in early pregnancy, before gestational diabetes is manifest.MethodsLipid fractions in maternal non-fasting serum collected around week 15 of pregnancy were profiled using direct infusion mass spectrometry in a subset Discovery Cohort (n = 200) of women from the Cambridge Baby Growth Study using direct infusion mass spectrometry. Associations between 151 haplotype-tag fetal polymorphisms in 16 imprinted genes and lipids were determined using partial least squares discriminant analysis. Variable importance in projection scores were used to identify those lipid species that contribute most to the underlying variation in the lipid profile and the concentrations of these species tested for associations with fetal imprinted gene alleles using linear regression. In an internal Validation Cohort (n = 567 women from the same cohort) the lipid fraction was profiled using liquid chromatography-mass spectrometry and tested for associations with the same fetal imprinted gene variants as above, followed by meta-analysis of associations from the Discovery and Validation Cohorts.ResultsThe most significant associations were between a monounsaturated triglyceride (44:1) and both paternally-transmitted fetal H19 rs7950932 (R = 0.14, p = 2.9 × 10− 3, n = 386) and maternally-transmitted fetal FAM99A rs7131362 (R = 0.18, p = 6.2 × 10− 3, n = 351; association with maternal-untransmitted allele R = 0.08, p = 0.07, n = 328). This same triglyceride isoform was also associated with subsequent week 28 fasting glucose concentrations (R = 0.09, p = 9.9 × 10− 3, n = 673) and homeostasis model assessment of insulin resistance (R = 0.09, p = 0.01, n = 664).ConclusionsFetal imprinted genes may influence maternal circulating clinically relevant triglyceride concentrations early in pregnancy.

Gestational diabetes - association of lipid profile in pregnancy with post-partum dysglycemia

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Association of Lipid Profile in Pregnancy with Preeclampsia, Gestational Diabetes Mellitus, and Preterm Delivery.

IntroductionDuring the last two trimesters of pregnancy, glucose is spared (for the foetus), while the concentration of fatty acids in plasma increases, which can create complications like preeclampsia, gestational diabetes mellitus (GDM), and preterm delivery.AimTo study the association of serum lipid levels during the second and third trimesters with the development of pregnancy-associated diseases, such as preeclampsia, GDM, and preterm delivery.Methods and MaterialsThe present study was carried out at MGM Hospital, Navi Mumbai, India. Two hundred antenatal cases from October 2012 to October 2014 were enrolled after giving an informed consent. A lipid profile was recorded for each subject and was later accessed. The lipid profile of the subjects having either GDM, preterm, or preeclampsia was further used to find an association with the individual disorders. Statistical analyses were performed using Statistical Package for Social Sciences (SPSS) version 20 (IBM SPSS Statistics, Armonk, NY). All reported p-values are two-tailed, and confidence intervals were calculated at the 95% level.ResultsIn preeclamptic patients, the mean systolic blood pressure was 151.40 mm/Hg and the mean diastolic blood pressure was 74.03 mm/Hg in the third trimester. In preeclamptic patients, the mean serum triglyceride levels in the second trimester were 204.00 mg/dl, while the mean was 243.20 mg/dl in the third trimester. In GDM patients, the mean serum triglyceride was 214.33 mg/dl in the second trimester, while it was 230.50 mg/dl in the third trimester. In patients with preterm, the mean triglycerides levels were 212.83 mg/dl and 240.16 mg/dl in the second and third trimesters, respectively. In preeclamptic patients, the mean serum cholesterol levels in the second trimester were 210 mg/dl, while in the third trimester, the mean was 243.60 mg/dl. In GDM patients, the mean serum cholesterol was 223.50 mg/dl and 242.83 mg/dl in the second and third trimester, respectively. The mean cholesterol levels in patients with preterm in second and third trimesters were 213.33 mg/dl and 243.66 mg/dl, respectively. Out of the total 200 patients, 168 had no complications, while 20 (10%) had preeclampsia, six (3%) had gestational diabetes mellitus, and the other six {3%} had preterm deliveries.ConclusionAn association between maternal early pregnancy triglyceridaemia and the subsequent risk of preeclampsia, gestational diabetes, and preterm deliveries was observed. The occurrence of preeclampsia, gestational diabetes, and preterm deliveries cannot be predicted based on the values of serum cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and very-low-density lipoprotein cholesterol (VLDL-C). Hence, estimation of lipid profile is strongly recommended during pregnancy to prevent the deleterious effect of hyperlipidaemia associated with pregnancy.

Early-Pregnancy Changes in Maternal Lipid Profile in Women with Recurrent Preeclampsia and Women with Normal Pregnancy

Background: “According to the current knowledge, changes in lipid profile in pregnancy is a major contributor in the pathogenesis of preeclampsia. The present study was designed to compare the changes in lipid profile in normal pregnancy and in patients with history of recurrent pre-eclampsia (PE).”Objective: Assessment the relationship between lipid profiles changes in women with history of recurrent preeclampsia in comparison to normal pregnancy in early pregnancy.Patients and Methods: Measurement of lipid profile changes in women with history of recurrent preeclampsia (more than two preeclampsia in previous pregnancies) at 12 to 16 weeks of pregnancy and compared to normal pregnancy as a control group who does not have history of preeclampsia also early in pregnancyResults: The patients with history of recurrent Preeclampsia had significantly higher mean total cholesterol level compared to controls (216.1 ± 25.5 mg/dl) and (195.6 ± 23.2 mg/dl), respectively, (P<0.05).The mean HDL cholesterol (HDL-C) level was significantly lower in PE group (49.3 ± 9.2 mg/dl) than controls (52.2 ± 8.4 mg/dl), (P<0.05). The mean level of LDL cholesterol was (122.3 ± 28.7) mg/dl in PE group and it was significantly higher than the (108.6 ± 26.8 mg/dl) of controls, (P<0.05). Similarly, the mean VLDL cholesterol was also higher in women with history of recurrent preeclampsia than control group, (44.8 ± 12.6) vs. (34.8 ± 7.3) mg/dl, respectively, (P<0.05). The Triglycerides (TG) was also elevated in women with history of recurrent preeclampsia where the mean TG level was (224.2 ± 63.1 mg/dl) compared to (174.6 ± 36.3mg/dl) in controls, (P<0.05).Conclusion: “This study showed that the women who have history of recurrent preeclampsia had disturbed lipid profile (increased levels of total TC, TG, VLDL-C and LDL-C concentration) in addition to decrease the high density lipoprotein cholesterol (HDL-C) level in subsequent pregnancy compared to normal pregnancy.”

Association of Thyroid Stimulating Hormone and Lipid Profile in Pregnancy

Introduction: Thyroid hormones have significant functions in embryogenesis and fetal development. Evidence suggests that thyroid stimulating hormone (TSH) may exert extra-thyroidal effects and modify the profile of blood lipids. Aim: To determine the association between maternal blood lipid profile and thyroid stimulating hormone in second and third trimester of pregnancy. Methods & Materials: The present study was carried out at MGM Hospital, Navi Mumbai, India. 200 antenatal cases from October, 2012 to October 2014 were enrolled after taking an informed consent. The blood samples for Thyroid stimulating hormone and lipid profile were taken at 16th and 32nd weeks. Results: The mean TSH level in second trimester was 1.53 mIU/L, with a standard deviation of 1.147 mIU/L. In third trimester, the mean TSH level was increased to 2.60 mIU/L with a standard deviation of 0.836mIU/L. The t-stat value was found to be -10.649 (p < 0.001). In third trimester, TSH was negatively correlated with Cholesterol (r= -0.214, p < 0.01) and VLDL (r= -0.148, p < 0.05). Conclusion: TSH levels rises according to the gestational age, being higher in third trimester as compared to second trimester. There is a significant negative correlation between TSH levels and cholesterol & VLDL in third trimester of the pregnancy. Hence, TSH levels should be looked for, especially in third trimester, in order to keep the thyroid related problems in check.
 Keywords: TSH, Lipid Profile, Pregnancy.

Association of Thyroid Stimulating Hormone and Lipid Profile in Pregnancy

Association of Thyroid Stimulating Hormone and Lipid Profile in Pregnancy

Study of Serum Malondialdehyde, Paraoxonase and Lipid Profile in Pregnancy with Pre-Eclampsia and Normal Pregnancy

Study of Serum Malondialdehyde, Paraoxonase and Lipid Profile in Pregnancy with Pre-Eclampsia and Normal Pregnancy

The Graded Relationship between Glucose Tolerance Status in Pregnancy and Postpartum Levels of Low-Density-Lipoprotein Cholesterol and Apolipoprotein B in Young Women: Implications for Future Cardiovascular Risk

Both gestational diabetes mellitus (GDM) and gestational impaired glucose tolerance (GIGT) identify women at risk of future cardiovascular disease, although the mediators of this risk are unknown. Because lipid factors can contribute to cardiovascular risk, we sought to characterize the relationship between gestational glucose tolerance status and lipid profile in pregnancy and the postpartum. Fasting lipids were measured in 482 women in pregnancy and at 3 months postpartum. Antepartum glucose challenge test (GCT) and oral glucose tolerance test (OGTT) defined four gestational glucose tolerance groups: GDM (n = 136), GIGT (n = 89), abnormal GCT with normal glucose tolerance (NGT) on OGTT (abnormal GCT NGT) (n = 170), and normal GCT with NGT on OGTT (normal GCT NGT) (n = 87). In pregnancy, there were no significant differences between the groups in total and low-density lipoprotein (LDL) cholesterol, triglycerides, total cholesterol to high-density lipoprotein (HDL) cholesterol ratio, apolipoprotein B (apoB), apolipoprotein A1 (apoA1), and apoB to apoA1 ratio. At 3 months postpartum, however, each of the following lipid parameters progressively increased from normal GCT NGT to abnormal GCT NGT to GIGT to GDM: total cholesterol (P = 0.0047), LDL (P = 0.0002), triglycerides (P = 0.0002), total cholesterol to HDL ratio (P < 0.0001), apoB (P = 0.0003), and apoB to apoA1 ratio (P = 0.0014). Furthermore, on multiple linear regression analyses, GDM emerged as an independent predictor of postpartum total cholesterol (t = 3.09, P = 0.0021), LDL (t = 3.81, P = 0.0002), triglycerides (t = 3.38, P = 0.0008), total cholesterol to HDL ratio (t = 3.76,P = 0.0002), apoB (t = 4.12, P < 0.0001), and apoB to apoA1 ratio (t = 3.07, P = 0.0023). GIGT was an independent predictor of postpartum total cholesterol to HDL ratio (t = 2.27, P = 0.0239), apoB (t = 2.04, P = 0.0416), and apoB to apoA1 ratio (t = 1.97, P = 0.049). Compared with their peers, women with GDM and GIGT have a more atherogenic lipid profile by 3 months postpartum, characterized by increased LDL and apoB.

Lipoprotein lipase PvuII polymorphism is associated with variations in serum lipid levels in non-diabetic pregnant women

The aim of the present study was to determine if there is an association between the single nucleotide polymorphisms (SNPs) of the lipoprotein lipase (LPL) and apolipoprotein E (apo E) genes and the serum lipid profile in pregnancy and puerperium. Non-diabetic women of European descent in the third semester of pregnancy (N = 120) were selected. Those with diseases or other condition that could modify their lipid profile were excluded from the study (N = 32). Serum lipids were measured by routine laboratory procedures and genomic DNA was extracted by a salting out method. LPL (PvuII and HindIII) and apo E (HhaI) SNPs were detected by the polymerase chain reaction and restriction fragment length polymorphism. Categorical and continuous variables were compared by the chi-square test and Student t-test or ANOVA, respectively. Women carrying the LPL P1P1 genotype had higher serum LDL cholesterol (N = 21; 155 +/- 45 mg/dL) than women carrying the P1P2/P2P2 genotypes (N = 67; 133 +/- 45 mg/dL; P = 0.032). During the puerperium period, serum levels of triglycerides and VLDL cholesterol were significantly reduced in women carrying the P1P1 (73%, P = 0.006) and P1P2 (51%, P = 0.002) genotypes but not in women carrying the P2P2 genotype (23%, P > 0.05). On the other hand, serum concentrations of lipids did not differ between the LPL HindIII and apo E genotypes during pregnancy and after delivery. We conclude that LPL PvuII SNP is associated with variations in serum lipids during pregnancy and the puerperal period in non-diabetic women.

Study of serum lipid profile in pregnancy induced hypertension

Four groups of subjects: normal healthy normotensive nonpregnant women (Group A), normal normotensive pregnant women (Group B), women with preeclamptic toxaemia (Group C) and eclamptic women (Group D): with fifty subjects in each group, were investigated for serum lipid profile in the third trimester of pregnancy. There was significant increase in serum triglyceride and VLDL cholesterol leve as well as decrease in LDL cholesterol in normal pregnancy, while total cholesterol and HDL cholesterol levels did not show any statistically significant alteration. The preeclampsia (Group C) was associated with a significant rise in triglyceride and VLDL cholesterol and fall in HDL cholesterol concentration, while eclamptic women showed significant fall in HDL cholesterol and rise in LDL cholesterol as compared to normal pregnant women. However, interestingly, elevation of the ratios of total cholesterol: HDL cholesterol and triglyceride: HDL cholesterol as well as diminuition of the ratio of HDL cholesterol: VLDL cholesterol showed statistical significance in pregnancy induced hypertension in both Groups C and D, while eclamptic women showed significant elevation of LDL cholesterol: HDL cholesterol ratio in addition.