Journal of Postgraduate Medicine
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Year : 1978  |  Volume : 24  |  Issue : 3  |  Page : 158-163  

A study of cholesterol/phospholipid ratio and triene/tetraene ratio in coronary heart disease

KG Tanksale 
 Department of Biochemistry and Nutrition, Seth G. S. Medical College, Parel, Bombay-400 012, India

Correspondence Address:
K G Tanksale
Department of Biochemistry and Nutrition, Seth G. S. Medical College, Parel, Bombay-400 012


The biochemical assessment of coronary heart diseases (CHD) is done by studying serum lipids. This is usually done to under­stand the pathogenesis o f atherosclerosis which is the cause o f CHD. Indoor patients suffering from CHD were studied for their serum cholesterol, phospholipids, total fatty acids and polyunsaturated fatty acids (PUFA). Cholesterol/phospholipid and triene/tetraene ratios were calculated. It was observed that there was no significant difference in any of the parameters studied on the basis of dietary habit or body size. It was further observed on the basis of triene/tetraene ratio that the patients were ingesting adequate amounts of linoleate, there were high levels of cholesterol, phospholipids and c/p ratio in all the groups. This paradox may be due to disturbed PUFA metabolism and particularly of linoleate so that there is no influence o f linoleate on cholesterol and phospholipid synthesis.

How to cite this article:
Tanksale K G. A study of cholesterol/phospholipid ratio and triene/tetraene ratio in coronary heart disease.J Postgrad Med 1978;24:158-163

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Tanksale K G. A study of cholesterol/phospholipid ratio and triene/tetraene ratio in coronary heart disease. J Postgrad Med [serial online] 1978 [cited 2023 May 31 ];24:158-163
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Study of blood lipids in coronary heart diseases (CHD) has become a common feature. The aim of these studies is to know the influence of dietary fat or a role played by blood-lipid fractions like choles­terol or phospholipids or triglycerides. Dietary poly-unsaturated fatty acids (PUFA) influence the levels of serum lipids like cholesterol, phospholipids and triglycerides. [1],[19],[21],[28] It was also shown by Beveridge et al [4] and Haust et a1 [17] that vegetable fats rich in PUFA are hypoch3­lesterolemic while animal fats are hyper­cholesterolemic. Higher quantity of dietary fat causes hypercholesterolemia [2] and as dietary fat is related to total calorie intake it is related to obesity which is one of the important risk factors in CHD. [22] The present investigation was undertaken to study the levels of PUFA in blood and its relation to serum cholesterol and phos­pholipids in patients suffering from CHD.

 Material and Methods

Male patients from indoor wards suffer­ing from CHD were selected for the pre­sent study. Those who had unequivocal electrocardiographic evidence were select­ed. Patients who had concurrent other ill­ness were not considered. All these patients came from the urban areas and be longed to middle socio-economic class. The age range of the patients was between 45 and 60 years. The body build and stature of these patients was also recorded. Similarly their dietary habits viz. vegetarian or non-vegetarian was also noted.

Fasting blood samples were collected of the\ first morning on their admission to th4 wards and serum was used to estimate total cholesterol by the method of Sperry and Webb [27] and total phospholipid by the method of Youngberg. [30] Total fatty acids were separated from serum by the method of Wiese and Hansen [29] and PUFA were estimated from them by alkali isomerisation spectrophotometric method of Herb and Riemenschnider. [18] For calculating individual PUFA, method of Hammon and Lundberg [16] was employed It was assumed that Pentaene consisted 50 per cent 22:5 and 50 per cent 20:5.


Patients studied were classified into groups on the basis of dietary habit and body size as obese and non-obese. [Table 1] gives the levels of total cholesterol and total phospholipids in all non-vegtarian as well as vegetarian subjects. This table also gives total cholesterol and total phos­pholipid values in sub-groups viz. obese and non-obese, vegetarians and non-vege­tarians. Cholesterol/phospholipid (c/p) ratio in these patients was in the range of 0.977 to 1.037. There was no significant difference in the levels of cholesterol, phospholipid or c/p ratio on the basis of dietary habits or body size.

[Table 2] shows the incidence of hyper­cholesterolemia in CHD both in vegeta­rians and non-vegetarians. This table also gives the mean values in normocholestero­lemic and hypercholesterolemic patients. There was no significant difference in the incidence of hypercholesterolemia in vege­tarians and non-vegetarians.

[Table 3] shows the levels of total fatty acids and various fractions of PUFA in patients belonging to various groups clas­sified on the basis of dietary habits and body size and these levels did not show significant difference on the basis of die­tary habit or body size. The triene/ tetraene ratio ranged between 0.287 to 0.375 and there was no specific relationship between this ratio and dietary habits or body size.


In the present study there was no signi­ficant difference in the total cholesterol levels on the basis of dietary habits. This was because there was very little varia­tion in the types of fat and its daily con­sumption by these patients. This is in conformity with the earlier results either in human subjects [13],[14],[21] or in rats. [5],[17] According to Miettinen, [23] obesity does not affect serum cholesterol levels and the present results are in agreement with this view. Similar observations were made in case of total phospholipids. [31]

In majority of the patients there way marked hypercholesterolemia with serum cholesterol levels much above 250 mg percent and hypercholesterolemia is respon­sible for development of atherosclerotic heart diseases. [9] Hypercholesterolemia it CHD has been also reported recently be several authors. [3],[10],[20],[26]

Hyperphospholipidemia in CHD with serum phospholipids above 270 mg percent has been reported by Cohen [7] any Carlson [6] and it was also observed in the present investigations. According to Grande et al [14] the type of dietary fat is not related to serum phospholipid level which was also confirmed from the present study.

According to Eilert [9] and Gertler et al [11],[12] instead of considering either cholesterol or phospholipid levels in serum, to consider c/p ratio as an index of atherogenesity is more significant [12] and Gertler suggested 0.78 as a normal c/p ratio. According to these authors, atherosclerosis which is responsible for CHD there is high c/p ratio which is also observed in the present study.

Study of total fatty acids and PUFA plasma of normal subjects has been done by Patil and Magar [25] who reported 343 ± 7.4 mg per cent as total fatty acids with PUFA being 34.38 per cent of the total. In comparison with these values higher levels of total fatty acids as well as petaene and hexaene were observed while levels of diene, triene and tetraene were observed to be lower. Similar results were also observed by Hagenfeldt et al [15] These changes in PUFA levels are not only due to dietary lipids but are also, probably, due to their disturbed metabolism. Ac­cording to Mohrhauer [24] triene/tetraene ratio is a measure of linoleate deficiency and this ratio of 0.4 or less indicates that the patients are ingesting adequate amounts of linoleate and the athero­sclerotic changes are minimised. In the present investigation triene / tetraene ratio is less than 0.4 in all the groups. Hence changes in PUFA pat­tern observed in CHD patients are prob­ably due to disturbances in their meta­bolism. It is confirmed from the fact that there is hypercholesterolemia and hyper­phospholipidemia in large number of cases inspite of ingestion of adequet amounts of linoleate which should have resulted in decrease in serum cholesterol levels [19] and phospholipid levels. [21]

From the present investigation it was concluded that the two indices viz. c/p and triene/tetraene are related to dietary fat which in turn is related to PUFA metabolism and rates of synthesis of cho­lesterol and phospholipid. [1],[19],[21] Even though ingestion of linoleate is indicated to be adequet from triene/tetraene ratio less than 0.4, there is high c/p ratio in all the groups which is probably due to distrubance in the PUFA metabolism caused by the acute illness [15] and depressing effect of linoleate on serum cholesterol and phospholipids is not seen.


Author is thankful to the Dean, Set. G.S. Medical College for the permission to publish this article.


1Alfin-Slater, R. B. and Aftergood, L. A Essential fatty acids-reinvestigate( Physiol. Rev., 48: 758-773, 1968.
2Allee, G. L., Baker, D. H. and Leveille G. A.: Fat utilization and lipogenesis in young pig., J. Nutr., 101: 1415-1421, 1971.
33, Barboriac, J. J., Rimm, A. A., Anderso: A. J., Tristani, F. E., Walker, J. A Fiemma, R. J. and Wisc, M.: Coronary artery occlusion and blood lipids. Amer Heart. J., 87: 716-721, 1974.
4Beveridge, J. M. R., Connel, W. F. any Mayer, G. A.: Plasma cholesterol depressant factor in corn oil. Fed. Proc., 16 11-19, 1957.
5Bloomfield, D. K.: Dynamics of cholesterol metabolism. I. Factors regulating total sterol biosynthesis and accumulation u the rat. Proc. Nat. Acad. Aci., 50: 117 124, 1963.
6Carlson, L. A.: Serum lipids in men with myocardial infarction. Acts. Med. Scand. 167: 399-413, 1960.
7Cohen, L.: Serum phospholipids in coronary artery disease. J. Lab. Clin. Med. 54: 352-356, 1959.
8Eilert, M. L.: The effect of estrogens upon the partition of the serum lipids in female patients. Amer. Heart J., 38: 472-476, 1949.
9Friedman, M.: The pathogenesis of coronary plaques, thrombosis and haemorrhages: An evaluative review. Circulation 52-Suppl. III: 34-40, 1975.
10Friedrickson, D. S.: Mutants, hyperlipo-proteinemia and coronary artery disease Brit. Med. J., 2: 187-192, 1971.
11Gertler, M. M. and Garn, S. M.: Cholesterol esters and phospholipids in health and coronary artery disease. Science, 112 14-16, 1950.
12Gertler, M. M., Garn, S. M. and Bland E. F.: Age, serum cholesterol and coro­nary artery disease. Circulation, 2: 517-522 1950.
13Gjone, R., Nordy, R., Blomoholf, J. P.and Wiencke. I.: The effects of unsaturat­ed and saturated dietary fats on plasma cholesterol, phospholipids and lecithin: cholesterol acyl transferase activity. Acts. Med. Scand. , 191: 481-484, 1972.
14Grande, F., Anderson, J. T. and Keys, A.: Diets of different fatty acid composition producing identical serum cholesterol levels in man. Amer. J. Clin. Nutr., 25: 53-60, 1972.
15Hagenfeldt, L. and Wester, P. 0.: Plasma levels of individual fatty acids in patients with acute myocardial infarction. Acta. Med. Scand., 194: 357-362, 1973.
16Hammond, E. G. and Lundberg, W. 0.: The alkali isomerisation of a methyl doco­sahexaenoate and the spectral properties of conjugated fatty acids. J. Amer. Oil Chem. Soc., 30: 433-437, 1953.
17Haust, H. L. and Beveridge, J. M. R.: Effect of varying type and quantity of dietary diet. Arch. Biochem. Biophys., 78: 367-372, 1958.
18Herb, S. F. and Reimenschneider, R. W.: Spectrophotometric micromethod for deter­mining poly-unsaturated fatty acids. Anal. Chem., 25: 953-963, 1953.
19Irritani, N. and Nogi, J.: Influence of lino­leate on cholesterol turnover in rats. J. Nutr., 104: 546-552, 1974.
20Keys, A., Christ, A., Blackburn, H., Buchem, F. S. P., Buzina, R., Djordjevic, B. S., Findaza, F., Karvonen, M. J., Meotti, A., Puddu, V. and Taylor, H. L.: Probability of Middle aged men developing coronary heart disease in five years. Cir­culation, 45: 815-820, 1972.
21MacDonald, I: Relationship between dietary carbohydrates and fats in their influence on serum lipid concentrations. Clinical Sci., 43: 265-274, 1972.
22Master, A. M. and Jaffe, H. L.: Relation­ship of obesity to coronary disease and hypertension. J. Amer. Med. Assoc., 153­1499-1501, 1953.
23Miettinen, T. A.: Cholesterol production in obesity. Circulation, 44: 842-850, 1971.
24Mohrauer, H. and Holman, R. T.: The effect of dose level of EPA upon fatty acid composition of the rat liver. J. Lipid Res., 4: 151-157, 1963.
25Patil, V. S. and Magar, N. G.: Fatty acids' of human blood. Biochem. J., 74: 427-429, 1960.
26Peter, D. S., Wood, M. P., Stern, A. S. and Gerald, M. R.: Prevalance of plasma lipoprotein abnormalities in a free-living population of the Central Valley of Cali­fornia. Circulation, 45: 114-120, 1972.
27Sperry, W. M. and Webb, M.: A revision of Schoenheimer-Sperry method for choles­terol determination. J. Biol. Chem., 202: 417-422, 1953.
28Teige, B. and Beare-Rogers, J. L.: Cardiac fatty acids in rats fed marine oils. Lipids, 8: 584-587, 1973.
29Wiese, H. F. and Hansen, A. F.: Semi­micro method for the determination of unsaturated fatty acids of blood serum. J. Biol. Chem., 202: 417-422, 1953.
30Youngberg, G. E. and Youngberg, M. V.: Phosphorus metabolism. I-System of blood phosphorus analysis. J. Lab. Clin. Med., 16: 158-166, 1930.
31Zucker, T. F. and Zucker, L. M.: Phos­phatides and cholesterol in the rat body: Effects of growth, diet and age. J. Nutr., 80: 20-24, 1963.

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