This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Medicine
[{'content': 'Best predictor for coronary artery disease \nSelect and explain. \nA. HDL, B. LDL, C. VLDL, D. Chylomicron', 'role': 'user'}, {'content': 'Answer: B \nExplanation: Elevated LDL cholesterol and decreased HDL cholesterol are independent predictors of coronary heart disease.\nAlthough there is consensus regarding the benefits\xa0of lowering LDL cholesterol the value of elevating HDL\ncholesterol remains controversial.\nLow HDL and coronary risk\nHigh serum HDL cholesterol is associated with a lower risk of CHD.\nThe incidence of CHD events in a normal population appears to be inversely related to serum HDL cholesterol with\nlow levels being associated with increased coronary risk.\nBased upon data from the Framingham Heart study, the risk for myocardial infarction increases by about 2 5% for\nevery 5mg/dl (.13 mmol/l) decrement in serum HDL cholesterol.\nElevated LDL and coronary risk\nElevation in LDL cholesterol is a well-known risk factor for the development of coronary artery disease.\nAssociation of elevated LDL with coronary artery disease has been established in various trials and studies.\nThere is linear reduction in cardiovascular disease with progressive lowering of the LDL cholesterol.\nTraditionally LDL levels are considered to be the most important factor in the prediction of coronary artery disease.\nThe importance of LDL as a risk factor lies in the fact that effective therapies are available to lower it, while it is not\nso in the case of HDL. So when treating dyslipidemia for reducing cardiovascular events, the first\xa0target is LDL and\nnot HDL.\nDoubt and Controversy\nWhat is creating doubts in our mind is a table from Braunwald 8th/e p1008 according to which ‘Low HDL’ appears to\nbe better marker for prediction of future cardiovascular disease than ‘High LDL’\nAccording to this bar diagram in Braunnwald 8th/e pl008 - the adjusted hazard ratio for future cardiovascular events\nfor LDL is 1.62 while that of HDL is 2.32. But the text given in the book does clarify which one is better marker, (we\nhave given this table from Braunwald in our previous discussion on this topic in Nov 2009 Medicine).\nWe have tried to confirm\xa0this ‘Low HDL’ fact from various other books. But none of the texts clearly favored any one\nbetween these 2 to be the better marker. Both LDL and HDL are mentioned to be important.\nWe have also consulted several cardiologist on this. All of them say that the answer should be LDL.\nWell, Braunwald is text book of immense reputation, and any information or text given in the book does not need\nconfirmation\xa0from any other source. But what has added to the confusion is that the latest edition of Braunwald i.e.,\n9th/e has eliminated that diagram from the book and in the text have not clarified\xa0which one is better marker.\nInstead, the text states that Apolipo (a) and B 100 are better marker for predicting future cardiovascular events than\nLDL and HDL.\nWe are not absolutely sure of the answer, but we would for the time being go with LDL.\nAlso Know\nThe following lipid and lipoprotein abnormalities are associated with increased coronary risk.\nElevated total cholesterol\nElevated LDL cholesterol\nLow HDL cholesterol\nIncreased total to HDL cholesterol ratio\nIncreased non HDL cholesterol\nHypertriglyceridemia\nIncreased Lp(a)\nIncreased apolipoprotein B\nSmall dense LDL particles', 'role': 'assistant'}]