Ability of the plasma concentration ratio of triglyceride/high-density lipoprotein cholesterol to identify increased cardio-metabolic risk in an east Asian population

Aim

The plasma concentration ratio of triglyceride (TG)/high-density lipoprotein cholesterol (HDL-C) has identified increased cardio-metabolic risk and outcome in European populations. The goal of this study was to see if this ratio would also have clinical utility in identifying cardio-metabolic risk in an East Asian population.

Methods

Measurements of various cardio-metabolic risk factors, including coronary calcium scores, were available on 12,166 apparently healthy Korean adults. Approximately 25% of men and women with the highest TG/HDL-C ratios were classified as being at high cardio-metabolic risk, and their risk factor profiles compared to the remainder of the population, as well as to individuals with the metabolic syndrome (MetS).

Results

High cardio-metabolic risk (upper 25%) was defined as a TG/HDL-C ratio ≥3.5 (men) or ≥2.0 (women), and all cardio-metabolic risk factors measured, including coronary calcium scores, were significantly more adverse when compared to individuals beneath these cut-points. Although cardio-metabolic risk profiles appeared reasonably comparable in subjects identified by either a high TG/HDL-C or a diagnosis of MetS, use of the TG/HDL-C increased the numbers at high risk.

Conclusion

Evidence that determination of the plasma TG/HDL-C concentration ratio provides a simple way to identify individual at increased cardio-metabolic risk has been extended to an East Asian population. The ability of an elevated TG/HDL-C ratio to accomplish this goal is comparable to that achieved using the more complicated MetS criteria.     

The triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio as a predictor of insulin resistance, β-cell function,and diabetes in Hispanics and African Americans

Objective

The TG/HDL-C ratio is used as a marker of insulin resistance (IR) in Caucasians; however, there is limited data in other ethnic groups. We hypothesized that the TG/HDL-C ratio is associated with IR in Hispanics and African Americans (AA).

Identification of Cardiometabolic Risk: Visceral Adiposity Index Versus Triglyceride/HDL Cholesterol Ratio

Background

The plasma concentration ratio of triglyceride (TG)/high-density lipoprotein cholesterol (HDL-C) can identify cardiometabolic risk and cardiovascular disease. The visceral adiposity index is a sex-specific index, in which measurements of body mass index and waist circumference are combined with TG and HDL-C concentrations. The current analysis was initiated to see if the visceral adiposity index would improve the ability of the TG/HDL-C to identify increased cardiometabolic risk and outcome.

Methods

Cardiometabolic data were obtained in 2003 from 926 apparently healthy individuals, 796 of whom were evaluated in 2012 for evidence of incident cardiovascular disease. The relationship between TG/HDL-C and values for visceral adiposity index was evaluated by Pearson's correlation coefficient. The relative risks for first cardiovascular event between individuals above and below the TG/HDL-C sex-specific cut points, and in the top quartile of visceral adiposity index versus the remaining 3 quartiles, were estimated using Cox proportional hazard models.

Results

TG/HDL-C concentration and visceral adiposity index were highly correlated (r = 0.99) in both men and women. Although more men (133 vs121) and women (73 vs 59) were identified as being at “high risk” by an elevated TG/HDL-C ratio, the individual cardiometabolic risk factors were essentially identical with either index used. However, the hazard ratio of developing cardiovascular disease was significantly increased in individuals with an elevated TG/HDL-C, whereas it was not the case when the visceral adiposity index was used to define “high risk.”

Conclusion

The visceral adiposity index does not identify individuals with an adverse cardiometabolic profile any better than the TG/HDL-C.     

High triglyceride to high‐density lipoprotein cholesterol ratio and arterial stiffness in postmenopausal Korean women

The ratio of triglyceride to high‐density lipoprotein cholesterol (TG/HDL) is positively linked to insulin resistance, and it has emerged as an independent predictor of cardiovascular disease. Menopause is characterized by various detrimental metabolic and vascular changes that may lead to high TG with low HDL cholesterol and arterial stiffness. Several epidemiological studies have reported that high TG/HDL ratio has a positive association with arterial stiffness in both adult and adolescent populations; it is not known whether TG/HDL ratio is related to brachial‐ankle PWV (baPWV) in postmenopausal women. Thus, the authors aimed to investigate the association between TG/HDL ratio and arterial stiffness as measured by baPWV in 434 postmenopausal women. The odds ratios (ORs) and 95% confidence intervals (95% CIs) for high baPWV were calculated after adjusting for confounding variables across TG/HDL ratio quartiles using multiple logistic regression analysis. The mean values of meaningful cardiometabolic variables increased with TG/HDL ratio quartiles. The adjusted baPWV (SEs) significantly increased with TG/HDL quartiles: Q1 = 1412 (22.1), Q2 = 1469 (21.4), Q3 = 1482 (21.0), and Q4 = 1505 (21.6) cm/s after adjusting for age, body mass index (BMI), and systolic blood pressure. The OR (95% CI) of the highest TG/HDL ratio quartile as compared to the lowest TG/HDL ratio quartile for high PWV was 2.77 (1.16‐6.63) after adjusting for age, BMI, smoking status, regular exercise, mean arterial pressure, fasting plasma glucose, total cholesterol level, hypertension, log‐transformed C‐reactive protein, and the use of antihypertensive and lipid‐lowering drugs. The TG/HDL ratio was positively and independently associated with arterial stiffness in postmenopausal Korean women.     

Uric acid to high-density lipoprotein cholesterol ratio predicts cardiovascular mortality in patients on peritoneal dialysis

Background and aimsSerum uric acid (UA) and high-density lipoprotein cholesterol (HDL-C) disorders are both considered as risk factors of cardiovascular mortality. The predictive value of UA to HDL-C ratio (UHR) has been validated in diabetes. However, association of UHR with cardiovascular (CV) mortality is undetermined in peritoneal dialysis (PD) patients.Methods and resultsIn this retrospective cohort study, we enrolled 1953 eligible incident patients who commenced PD treatment on our hospital from January 1, 2006 to December 31, 2015, and followed up until December 31, 2019. Of the participants, 14.9% were older than 65 years (mean age 47.3 ± 15.2 years), 24.6% were diabetics, and 59.4% were male. Patients were categorized into quartiles according to baseline UHR level. Multivariate Cox Proportional Regression analysis was applied to explore the association of UHR with mortality. Overall, 567 patients died during a median follow-up period of 61.3 months, of which 274 (48.3%) were attributed to CV death. The mean baseline UHR was 16.4 ± 6.7%. Compared to quartile 2 UHR, hazard ratios (HRs) for the highest quartile UHR were 1.35 (95% confidence interval [CI] 1.06–1.78; P = 0.017) and 1.46 (95% CI 1.00–2.12; P = 0.047) for all-cause and CV mortality, respectively. Subgroup analysis showed that association of UHR with CV mortality was remarkable among PD patients with age ≥65 years, malnutrition (albumin <35 g/L), diabetes, and CVD history.ConclusionsAn elevated UHR predicted increased risk of all-cause and CV mortality in PD patients.     

The triglyceride/high-density lipoprotein cholesterol ratio, the small dense low-density lipoprotein phenotype, and ischemic heart disease risk

This study investigated the relevance of using the plasma triglyceride to high-density lipoprotein cholesterol ratio (Log TG/HDL-C) for the prediction of the small dense lowdensity lipoprotein (LDL) phenotype and the risk of ischemic heart disease (IHD). Analyses were based on data from the Quebec Cardiovascular Study in a cohort of 2072 men free of IHD at baseline, among whom 262 had a first IHD event (coronary death, non fatal myocardial infarction and unstable angina) during a 13-year follow-up period. LDL particle size phenotype was characterized using 2-16% polyacrylamide gradient gel electrophoresis (PAGGE) of whole plasma. There were significant associations between the Log TG/HDL-C ratio and features of LDL size phenotype such as the proportion of LDL with a diameter <255A (r = 0.43, p < 0.001) and LDL peak particle size (r = -20.55, p < 0.001). However, the Log TG/HDL-C ratio brought no additional value (p a yen 0.1) in predicting the small dense LDL phenotype (area under the receiver operating curve (AUROC = 71.9%) compared to TG alone (AUROC = 71.2%) or to a combination of Log TG and HDL-C (AUROC = 72.4%) after multivariate adjustment for non lipid risk factors. Finally, elevations in the Log TG/HDL-C ratio did not improve the discrimination of incident IHD cases from non IHD cases compared to the use of plasma TG levels alone (p = 0.5) or a combination of the individual TG and HDL-C values (p = 0.5). The Log TG/HDL-C ratio does not improve our ability to identify individuals with the small dense LDL phenotype compared to plasma TG levels alone. The Log TG/HDLC is also not superior to plasma TG levels alone in predicting IHD risk in men of the QuA(c)bec Cardiovascular Study.     

Accuracy of the triglyceride to high-density lipoprotein cholesterol ratio for prediction of the low-density lipoprotein phenotype B

This study examined the accuracy of a triglyceride/high-density lipoprotein (HDL) cholesterol ratio of 3.8 for the prediction of low-density lipoprotein (LDL) phenotype B. The ratio of 3.8 was based on Adult Treatment Panel recommendations for normal fasting triglycerides (<150 mg/dl) and HDL cholesterol (>40 mg/dl). Fasting blood samples were obtained from 658 patients. LDL phenotype analysis was performed by nuclear magnetic resonance spectroscopy. A triglyceride/HDL cholesterol ratio of 3.8 divided the distribution of LDL phenotypes with 79% (95% confidence interval [CI] 74 to 83) of phenotype B greater than and 81% (95% CI 77 to 85) of phenotype A less than the ratio of 3.8. The ratio was reliable for identifying LDL phenotype B in men and women.     

Triglyceride to high-density lipoprotein cholesterol ratio and risk of atherosclerotic cardiovascular disease in a Chinese population

Background and aimsTriglyceride (TG) to high-density lipoprotein cholesterol (HDL-C) ratio may play a role in predicting cardiovascular events. We aimed to prospectively explore the association between the TG/HDL-C ratio and atherosclerotic cardiovascular disease (ASCVD), ischemic stroke, as well as coronary heart disease (CHD) in a Chinese population.Methods and resultsThis prospective cohort study included 9368 participants from four Chinese populations in the People's Republic of China–United States of America (PRC-USA) Collaborative Study of Cardiovascular and Cardiopulmonary Epidemiology. Over a follow-up period of 20 years, 624 cases of ASCVD events including 458 ischemic stroke events and 166 CHD events were recorded. The relationship between the TG/HDL-C ratio and the endpoints was evaluated through multivariate Cox proportional hazard models adjusted for potential confounding variables, including age, sex, urban or rural residence, northern or southern China, occupational type, education, physical exercise, smoking status, drinking status, body mass index, hypertension, high low-density lipoprotein cholesterol, diabetes, and antihypertensive medication use at baseline. With the lowest TG/HDL-C tertile as the reference, the middle and highest tertiles had the hazard ratios (HRs) and 95% confidence intervals (CIs) of 1.13 (0.91, 1.40), 1.36 (1.10, 1.67) respectively for ASCVD (p for trend = 0.0028), and 1.19 (0.93, 1.54),1.47 (1.15, 1.87) respectively for ischemic stroke (p for trend = 0.0016). However, no significant association was found for CHD events.ConclusionTG/HDL-C ratio was positively associated with the risk of ASCVD and ischemic stroke events in the Chinese population.     

Targeting high-density lipoprotein cholesterol in the management of cardiovascular disease

The association between low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol and the development of coronary heart disease (CHD) is well established. The management of CHD has traditionally focused on the reduction of LDL cholesterol or on the total lipid profile. Yet, treatment strategies for reducing risk in CHD also requires a focus on increasing low HDL cholesterol, as LDL cholesterol reduction alone is insufficient in preventing CHD events. This article reviews the strategies for targeting HDL cholesterol to optimize outcomes in CHD.     

社区老年人群尿微量白蛋白/尿肌酐比值与心血管病危险因素的关系

目的 研究社区65岁及以上老年人群尿微量白蛋白/尿肌酐比值(UACR)现况及其与心血管病危险因素的关系.方法 对"十一五"国家科技支撑计划"慢性心力衰竭早期预警和失代偿期综合防治的研究"的社区队列研究中一个农村社区所有65岁及以卜老年人进行包括心血管病危险因素在内的基线情况调查,并留取清晨点时间尿样检测尿微量白蛋白、尿肌酐和UACR等,分析UACR在健康人群以及具有心血管病危险因素人群中的分布情况.结果 (1)完成调查的65岁及以上老年人共1718名,其中男性721名,女性997名,年龄(73.3±5.5)岁.(2)调查的老年人群中,有至少1种心血管病危险因素者占78.00%,患病率排在前3位的心血管病危险凶素依次是血脂异常、高血压和糖尿病,其患病率分别为61.06%、44.59%和13.80%.(3)健康人群UACR中位数为13.81(6.03～26.51)μg/mg,其中男性为5.49(2.92～9.76)μg/mg,女性为17.12(7.28～33.28)μg/mg,女性显著高于男性(P<0.01).(4)具有高血压、糖尿病和血脂异常人群的UACR分别为16.27(6.65～42.00)μg/mg、26.27(10.92～76.65)μg/mg和16.39(6.98～41.03)μg/mg,均高于健康人群(P<0.05或P<0.01).(5)具有0、1、2,3和4个心血管病危险因素人群的UACR中位数分别为13.81(6.03～26.51)μg/mg、15.76(6.79～36.44)μg/mg、13.82(5.68～34.43)μg/mg、16.47(6.07～50.56)μg/mg和18.63(11.26～83.09)μg/mg,具有4个危险因素人群的UACR水平显著高于无危险因素人群(P<0.05).结论 65岁及以上社区老年人群患病率排在前3位的心血管病危险因素依次是血脂异常、高血压和糖尿病,三者均与UACR增高有关.

Abstract：

objective To determine the value of the urinary microalbumin/creatinine ratio (UACR)and the relationship between UACR and traditional cardiovascular risk factors among elderly community subjects.Methods A representative population in Shanghai rural district aged more than 65years who participated in the heart health survey of the key projects in the national science and technology pillar program in the eleventh five-year plan period of China were sampled via a clustered complex sampling method.A midstream collection from the first morning void collected was used to measure the urinary microalbumin,the urinary creatinine and the UACR.Baseline information including traditional cardiovascular risk factors were obtained by standard questionaire to analyze the distribution status of UACR in the population with or without the risk factors.Results (1)There were 1718 subjects(721 males)of(73.3±5.5)years included in this study.(2)The prevalence of with at least one cardiovascular risk factor was 78.00%in this cohort,the top there risk factors were dyslipidemia(61.06%),hypertension(44.59%)and diabetes(13.80%).(3)The median(the lower quartile-the upper quartile)of the UACR of the population without cardiovascular diseases and risk factors was 13.81(6.03-26.51)μg/mg.The level of UACR was significantly higher in females than that in males[17.12(7.28-33.28)μg/mg vs.5.49(2.92-9.76)μg/mg,P<0.01].(4) The level of UACR in population with hypertension,diabetes or dyslipidemia was 16.27(6.65-42.00)μg/mg,26.27(10.92-76.65)μg/mg and 16.39(6.98-41.03)μg/mg respectively,all exceeding that of the healthy group(P<0.05 or P<0.01).(5)The levels of UACR increased in proportion to the increase of cardiovascular risk factor numbers, the UACR of the population with 0, 1,2, 3 and 4 cardiovascular risk factors were 13. 81 (6. 03 - 26. 51 ) μg/mg, 15.76(6.79-36.44)μg/mg, 13.82 (5.68-34.43) μg/mg, 16.47 (6.07-50.56) μg/mg and 18.63( 11.26 - 83.09 ) μg/mg, respectively. The population with 4 cluster of cardiovascular risk factors posed the higher level of UACR than that of population with 0 cardiovascular risk factors ( P < 0. 05 ). Conclusions The three most common risk factors of cardiovascular diseases among the elderly community subjects aged more than 65 years are dyslipidemia, hypertension and diabetes, all of which are related to the elevation of UACR.     

LDL-C/HDL-C比值对经皮冠脉介入术后患者心血管事件的预测价值

目的 评估低密度脂蛋白胆固醇(LDL-C)/高密度脂蛋白胆固醇(HDL-C)比值对经皮冠脉介入(PCI)术后患者心血管事件的预测价值.方法 选择急性冠脉综合征(ACS)并予前降支置入支架的患者119例,依据血浆LDL-C/HDL-C比值将患者分为3组,随访1年,评估三组患者心血管事件发生率,以及各危险因素与心血管事件发生率的关系.结果 ①与LDL-C/HDL-C比值较低的两组相比,比值较高组患者体重指数、女性患者百分率、吸烟人数及糖化血红蛋白、高敏C反应蛋(hs-CRP)、总胆固醇和LDL-C水平均明显升高,而HDL-C水平和他汀类药物使用率则较低(P＜0.05).②第1组风险比(HR)1.04,95％可信区间(CI)0.98～1.08,第2组HR 1.16,95％CI 1.08～1.20,第3组HR 1.27,95％CI 1.19～1.36(P＜0.05).随着LDL-C/HDL-C比值的升高,PCI术后1年患者心血管事件发生率也逐渐升高(P＜0.05).③Cox比例风险回归模型提示,LDL-C/HDL-C比值对PCI术后心血管事件风险的预测价值优于其他危险因素.结论 LDL-C/HDL-C比值对PCI术后患者1年内心血管事件再发具有一定的预测价值.     

甘油三酯/高密度脂蛋白胆固醇比值与缺血性脑卒中患者颈动脉斑块不稳定性的相关性

目的探讨缺血性脑卒中(IS)患者甘油三酯/高密度脂蛋白胆固醇比值(TG/HDLC)与颈动脉斑块不稳定性的相关性。方法回顾性纳入2019年1月—2020年1月期间在保定市第一中心医院神经内科就诊的急性IS患者594例。所有研究对象均行超声检查了解颈动脉斑块情况,并依据超声结果将研究对象分为无斑块组(105例)、稳定性斑块组(63例)、不稳定性斑块组(426例)。全自动生化分析仪检测常规生物化学指标及各血脂指标,比较各组的危险因素、生物化学指标及血脂的差异。采用多变量Logistic回归分析评估颈动脉斑块不稳定性的影响因素,并计算优势比(OR)及95%可信区间(95%CI)。采用受试者工作特征(ROC)曲线分析TG/HDLC对颈动脉斑块不稳定性的预测价值。结果594例IS患者中,无颈动脉狭窄105例,有颈动脉狭窄489例,其中轻度狭窄439例,中度狭窄20例,重度狭窄30例。不稳定性斑块组的男性、体质指数(BMI)、吸烟史、饮酒史、血红蛋白、TG/HDLC高于稳定性斑块组,年龄、HDLC低于稳定性斑块组(P<0.05)。多变量Logistic回归分析显示,TG/HDLC是颈动脉斑块不稳定性的独立危险因素(OR 1.618,95%CI 1.027~2.551,P=0.038)。ROC曲线分析显示,TG/HDLC预测颈动脉斑块不稳定性的曲线下面积为0.619(95%CI 0.542~0.696),最佳截断值为1.60,灵敏度为35.4%,特异度为84.1%。结论TG/HDLC是IS患者颈动脉斑块不稳定性的独立危险因素,对颈动脉不稳定性斑块有一定预测价值。     

ApoB/apoA-I ratio is better than LDL-C in detecting cardiovascular risk

Background and aims

Cardiovascular (CV) events occur even when LDL-C are <100 mg/dL. To improve the detection of CV risk we investigated the apoB/apoA-I ratio versus LDL-C in subjects considered normal glucose tolerant (NGT) by oral glucose tolerance test (OGTT).

Methods and results

We enrolled 616 NGT (273 men and 343 women), and we measured insulin resistance, lipid profile, apoB/apoA-I and the factors compounding the metabolic syndrome (MetS). An unfavourable apoB/apoA-I (≥0.9 for males and ≥0.8 for females) was present in 13.9% of 108 patients with LDL-C <100 mg/dL: compared to subjects with lower apoB/apoA-I (<0.9 for males and <0.8 for females), they had more elements of MetS and their lipid profile strongly correlated with high CV risk. Out of 314 patients with lower apoB/apoA-I, 40.12% had LDL-C ≥130 mg/dL: these retained a more favourable lipid profile than corresponding subjects with elevated apoB/apoA-I ratio. Finally, we found a significant correlation between LDL-C and apoB/apoA-I ratio (r = 0.48, p <0.0001).

Conclusions

In NGT with LDL-C <100 mg/dL, a higher apoB/apoA-I exhibited an atherogenic lipid profile, indicating that LDL-C alone is insufficient to define CV risk. Independent from LDL-level, when apoB/apoA-I is lower, the lipid profile is, in fact, less atherogenic. This study demonstrates that apoB/apoA-I is at least complementary to LDL-C in identifying the “effective” CV risk profile of asymptomatic NGT subjects.     

Usefulness of the total cholesterol to high-density lipoprotein cholesterol ratio in predicting angiographic coronary artery disease in women

To investigate the relation between lipids and angiographic coronary artery disease (CAD) in women, fasting lipid profiles were obtained on 108 women undergoing coronary angiography (group I). CAD, defined as ≥25% luminal diameter narrowing in a major coronary artery, was present in 57 (53%). Neither serum total cholesterol nor triglyceride levels correlated with the presence of CAD. Mean total/high-density lipoprotein (HDL) cholesterol ratio was higher among women with than without CAD (5.5 ± 0.3 vs 4.2 ± 0.2, p < 0.0001). Multiple regression analyses identified a higher total/HDL cholesterol ratio as the variable most predictive of the presence (p < 0.001), extent (number of narrowed arteries) (p < 0.0001), and severity (% maximum stenosis) (p < 0.001) of CAD. Age and lack of estrogen use were also independently associated with the presence of CAD, age and lowdensity lipoprotein cholesterol level were additional indicators of extent, and age was the only other discriminator of severity of CAD.

In 56 women with total cholesterol <200 mg/dl (group II), mean total/HDL cholesterol ratio was higher in women with (n = 24) than without CAD (4.3 ± 0.2 vs 3.5 ± 0.2, P = 0.01). Higher total/HDL cholesterol ratio was the variable most predictive of the presence of CAD (p = 0.01), and the tone variable associated with severity (p < 0.001) after adjustment for other risk factors. Age was independently associated with presence and extent, and hypertension was also independently related to extent. Thus, among these women, total/HDL cholesterol ratio is the best predictor of the presence, severity and extent of CAD in general, and is the best predictor of presence, and severity in patients with total cholesterol <200 mg/dl.     

Relation among the plasma triglyceride/high-density lipoprotein cholesterol concentration ratio, insulin resistance, and associated cardio-metabolic risk factors in men and women

Results of recent studies using the ratio of plasma triglyceride (TG) to high-density lipoprotein (HDL) cholesterol concentration to identify insulin-resistant patients at increased cardiometabolic risk have emphasized that the cut point used for this purpose will vary with race. Because TG and HDL cholesterol concentrations vary with gender, this analysis was initiated to define gender-specific plasma TG/HDL cholesterol concentration ratios that best identified high-risk subjects among women (n = 1,102) and men (n = 464) of primarily European ancestry. Insulin resistance was defined as the 25% of the population with the highest values for fasting plasma insulin concentration and homeostasis model assessment of insulin resistance. Using TG/HDL concentration ratios >2.5 in women and >3.5 in men identified subgroups of men and women that were comparable in terms of insulin resistance and associated cardiometabolic risk, with significantly higher values for fasting plasma insulin, homeostasis model assessment of insulin resistance, blood pressure, body mass index, waist circumference, and glucose and TG concentrations and lower HDL cholesterol concentrations than in women and men below these cut points. The sensitivity and specificity of these gender-specific cut points to identify insulin-resistant subjects were about 40% and about 80%, respectively. In conclusion, the plasma TG/HDL cholesterol concentration ratio that identifies patients who are insulin resistant and at significantly greater cardiometabolic risk varies between men and women.