Low density lipoprotein cholesterol level inversely correlated with coronary flow velocity reserve in patients with Type 2 Diabetes

Objectives To evaluate the association of coronary artery endothelial function and plasma levels of low density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C) in patients with Type 2 Diabetes Mellitus (DM). Methods We investigated 90 participants from our institution between October 2007 to March 2010: non-DM (n = 60) and DM (n = 30). As an indicator of coronary endothelial dysfunction, we used non-invasive Doppler echocardiography to quantify coronary flow velocity reserve (CFVR) in the distal part of the left descending artery after rest and after intravenous adenosine administration. Results Plasma level of LDL-C was significantly higher in patients with DM than in non-DM (3.21±0.64 vs. 2.86±0.72 mmo/L, P < 0.05), but HDL-C level did not differ between the groups (1.01 ± 0.17 vs. 1.05 ± 0.19 mmo/L). Furthermore, the CFVR value was lower in DM patients than non-diabetics (2.45 ± 0.62 vs. 2.98 ± 0.68, P < 0.001). Plasma levels of LDL-C were negatively correlated with CFVR in all subjects (r = -0.35, P < 0.001; 95% confidence interval (CI): -0.52 - -0.15) and in the non-DM (r = -0.29, P < 0.05; 95% CI:-0.51 - -0.05), with an even stronger negative correlation in the DM group (r = -0.42, P < 0.05; 95% CI:-0.68 - -0.06). Age (β = 0.019, s = 0.007, sβ = -0435, 95% CI: -0.033 - -0.055, P = 0.008), LDL-C (β = -0.217, s = 0.105,sβ= -0.282, 95% CI: -0.428 - -0.005, P = 0.045) remained independently correlated with CFVR in the DM group. However, we found no correlation between HDL-C level and CFVR in any group. Conclusions Diabetes may contribute to coronary artery disease (CAD) by inducing dysfunction of the coronary artery endothelium. Increased LDL-C level may adversely impair coronary endothelial function in DM. HDL-C may lose its endothelial-protective effects, in part as a result of pathological conditions, especially under abnormal glucose metabolism.     

2型糖尿病患者颈动脉内-中膜厚度和LDL/HDL胆固醇比值对冠状动脉狭窄的预测价值

目的 探讨2型糖尿病患者颈动脉内-中膜厚度（IMT）和低密度脂蛋白（LDL）/高密度脂蛋白（HDL）胆固醇比值对冠状动脉（冠脉）狭窄的预测价值.方法 112例2型糖尿病患者根据冠脉造影结果分成冠心病组（冠脉狭窄≥50％,67例）和对照组（冠脉狭窄0～49％,45例）,超声检测颈动脉最大IMT（max-IMT）,抽血检测LDL、HDL胆固醇水平.结果 冠心病组max-IMT、LDL/HDL均明显大于对照组[（2.65±0.75）mm比（1.59±0.47）mm,3.1±0.9比2.5±0.7,均P＜0.05].Spearman秩相关分析显示,max-IMT和冠脉狭窄率呈正相关关系（r=0.46,P＜0.05）.ROC曲线分析显示,max-IMT、LDL/HDL和二者联合指标预测冠脉狭窄的曲线下面积（AUC）分别为0.702、0.617和0.888.结论 2型糖尿病患者颈动脉max-IMT、LDL/HDL与冠脉狭窄密切相关,联合max-IMT和LDL/HDL可更好预测冠脉狭窄.     

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.     

Oxidized low-density lipoprotein and high-density lipoprotein cholesterol modulate coronary arterial remodeling: an intravascular ultrasound study

BACKGROUND: Oxidized low-density lipoprotein (oxLDL) not only plays an important role in plaque formation, but also impairs the endothelium-dependent relaxation. Constrictive remodeling rather than intimal hyperplasia mainly contributes to restenosis after balloon angioplasty. Probucol (powerful antioxidant) reduced restenosis rate by improving constrictive remodeling. Thus, oxLDL may modulate coronary arterial remodeling. HYPOTHESIS: The study was designed for using intravascular ultrasound to test the hypothesis that arterial constrictive remodeling (CR) was associated with oxLDL in patients with coronary artery disease. METHODS: Intravascular ultrasound was performed in 36 patients with de novo atherosclerotic coronary. Remodeling was defined and evaluated as follows: remodeling index (RI) = lesion vessel area (VA)/(proximal reference VA + distal reference VA)/2. Constrictive remodeling (CR) was defined as remodeling index (RI) < 0.9. Neutral and expansive remodeling (NER) was defined as RI > or = 0.9. The level of plasma ox-LDL was measured by sandwich ELISA using the monoclonal antibody (DLH3)-recognized oxidatively modified lipoproteins and the antihuman apoprotein B monoclonal antibody. RESULTS: Neutral and expansive remodeling was found in 24 lesions, and CR in 12 lesions. Remodeling index was significantly lower in the CR group than in the NER group (0.8 +/- 0.1 vs. 1.0 +/- 0.1, p < 0.001). The level of oxLDL in the CR group was significantly higher than that in the NER group (24.0 +/- 12.1 vs. 16.4 +/- 6.2 U/ml, p < 0.05). The level of high-density lipoprotein-cholesterol (HDL-C) in the CR group was significantly lower than that in the NER group (40.5 +/- 4.8 vs. 46.2 +/- 10.6 mg/ml, p < 0.05). There was a statistically significant correlation between the value of HDL-C/ ox-LDL and the RI (r = -0.48, p < 0.005). CONCLUSIONS: Oxidized LDL and HDL-C were associated with arterial remodeling in de novo atherosclerotic lesions.     

Clinical significance of high-density lipoprotein cholesterol in patients with low low-density lipoprotein cholesterol.

OBJECTIVES: We sought to evaluate the significance of high-density lipoprotein cholesterol (HDL-C) in the context of low low-density lipoprotein cholesterol (LDL-C). BACKGROUND: Earlier studies support an inverse correlation between circulating HDL-C and coronary risk in patients with normal or elevated LDL-C. METHODS: This study involved 4,188 patients attending the Palo Alto Veterans Administration Medical Center or affiliated clinics with LDL-C levels below 60 mg/dl. Outcomes were examined 1 year after the index LDL-C date. The combined primary end point was myocardial injury or hospitalization from ischemic heart disease. The secondary end point was all-cause mortality. RESULTS: Mean HDL-C levels (mg/dl) by quartile (Q) were: Q1 28 mg/dl, Q2 36 mg/dl, Q3 43 mg/dl, and Q4 63 mg/dl. The rate of myocardial injury or hospitalization for ischemic heart disease showed an inverse relationship to HDL-C (adjusted odds ratios: Q1 1.59 [95% confidence interval (CI) 1.16 to 2.19], Q2 1.39 [95% CI 1.01 to 1.92], Q3 1.33 [95% CI 0.96 to 1.84], and Q4 reference) that persisted regardless of statin use or recent myocardial injury. Analyzing HDL-C as a continuous variable revealed a 10% [95% CI 3% to 17%] increase in the combined end point of myocardial injury or hospitalization for ischemic heart disease for every 10-mg/dl decrease in HDL-C. The unadjusted and adjusted incidence of all-cause mortality demonstrated a U-shaped relationship to HDL-C (adjusted odds ratios: Q1 1.13 [95% CI 0.79 to 1.62], Q2 0.97 [95% CI 0.67 to 1.40], Q3 0.74 [95% CI 0.50 to 1.09], and Q4 reference). CONCLUSIONS: The inverse relationship between HDL-C and coronary risk persists even among patients with LDL-C below 60 mg/dl, although a U-shaped relationship is observed between HDL-C and all-cause mortality.     

High-density lipoprotein, but not low-density lipoprotein cholesterol levels influence short-term prognosis after acute coronary syndrome: results from the MIRACL trial.

AIMS: Patients with acute coronary syndrome (ACS) in the Myocardial Ischaemia Reduction with Aggressive Cholesterol Lowering (MIRACL) study had diminished cardiovascular events after 16 weeks of treatment of atorvastatin 80 mg daily. We determined whether plasma lipoproteins at baseline and then at 6 weeks after randomization predicted clinical outcome. METHODS AND RESULTS: Cox proportional hazards models were constructed to determine relations between lipoproteins and clinical endpoint events. Baseline LDL cholesterol (LDL-C) did not predict outcome. In contrast, baseline HDL-C predicted outcome with a hazard ratio of 0.986 per mg/dL increment in HDL-C, P<0.001, indicating 1.4% reduction in risk for each 1 mg/dL increase in HDL-C. Atorvastatin treatment profoundly lowered LDL-C, but had minimal effect on HDL-C. Neither Week 6 LDL-C nor absolute change of LDL-C from baseline by Week 6 had any significant impact on clinical endpoints occurring between Week 6 and Week 16 after randomization. CONCLUSION: Plasma HDL-C, but not LDL-C, measured in the initial stage of ACS predicts the risk of recurrent cardiovascular events over the ensuing 16 weeks. LDL-C reduction does not account for the clinical risk reduction with atorvastatin treatment after ACS. This finding may suggest that the clinical benefit of atorvastatin after ACS is mediated by qualitative changes in the LDL particle and/or by non-lipid (pleiotropic) effects of the drug.     

Lecithin:cholesterol acyltransferase activity and high-density lipoprotein subfraction composition in type 1 diabetic patients with improving metabolic control

On initial diagnosis or when metabolic control is poor, subjects with type 1 (insulin-dependent) diabetes mellitus often exhibit decreased high density lipoprotein (HDL) cholesterol levels, which have been associated in numerous studies in non-diabetic subjects with atherosclerosis and coronary artery disease. We measured the activities of plasma lecithin:cholesterol acyltransferase (LCAT), post-heparin lipoprotein lipase, and the composition of the HDL subfractions HDL₂ and HDL₃, in ten poorly controlled type 1 diabetic patients admitted to a metabolic ward (six women and four men, aged 18–37 years). The measurements were repeated after metabolic control had been optimised and again a week after discharge. The results were compared with those of ten healthy normolipidaemic subjects matched for age, sex and body mass. LCAT activity increased significantly (P<0.05) with improved metabolic control in the diabetic patients, and showed positive within — person correlation with HDL₂ cholesterol ester (r=0.67;P<0.01), HDL₂ free cholesterol (r=0.67;P<0.01), phosphatidylcholine (r=0.49;P<0.05), total phospholipids (r=0.50;P<0.01) and apolipoprotein A-I (apo A-I:r=0.72;P<0.01). With improving metabolic control HDL₂ lipid levels increased more than twofold and the compositional changes in HDL₂ were reflected by an increased apo A-I:apo A-II ratio (P<0.05) and a decreased triglyceride:apo A-I ratio (P<0.05). Changes in HDL₃ levels and composition were minor. The results of this study indicate that an increase in LCAT activity increases the concentration and changes the composition of HDL₂ in type 1 diabetic patients with improved metabolic control.     

Beyond low-density lipoprotein cholesterol: defining the role of low-density lipoprotein heterogeneity in coronary artery disease

Recent clinical trials in patients with coronary artery disease (CAD) provide evidence that low-density lipoprotein cholesterol (LDL-C) levels should be lowered even further to prevent recurrent CAD. However, despite more aggressive interventions for lowering LDL-C levels, the majority of CAD events go undeterred, perhaps related to the fact that intervention was not started earlier in life or that LDL-C levels represent an incomplete picture of atherogenic potential. Nevertheless, LDL-C remains the contemporary standard as the primary goal for aggressive LDL reduction. If triglycerides are >200 mg/dl, the measurement of non-high-density lipoprotein cholesterol (HDL-C) is recommended. Measurement of apolipoprotein (apo)B has been shown in nearly all studies to outperform LDL-C and non-HDL-C as a predictor of CAD events and as an index of residual CAD risk. This is because apoB reflects the total number of atherogenic apoB-containing lipoproteins and is a superior predictor of the number of low-density lipoprotein particles (LDL-P). Estimates of LDL-P and size can also be made by nuclear magnetic resonance spectroscopy, density gradient ultracentrifugation, and gradient gel electrophoresis. Although a number of studies show that such estimates predict CAD, LDL-P, and size often accompany low HDL-C and high triglyceride levels, and therefore such additional lipoprotein testing has not been recommended for routine screening and follow-up. Because apoB is a superior predictor of LDL-P, we recommend that apoB and the apoB/apoA-I ratio be determined after measurement of LDL-C, non-HDL-C, and the ratio of total cholesterol/HDL-C to better predict CAD and assess efficacy of treatment.     

Serum folate modified the association between low-density lipoprotein cholesterol and carotid intima-media thickness in Chinese hypertensive adults

Background and aimsWhile folate is known for its importance in cardiovascular health, it is unknown whether folate status can modify the association between low-density lipoprotein cholesterol (LDL-C) and carotid intima-media thickness (CIMT). We aimed to investigate this question in a Chinese hypertensive population, who are at high-risk of low folate and atherosclerosis.Methods and resultsThis report included 14,970 hypertensive adults (mean age 64.5 years; 40.3% male) from the China Stroke Primary Prevention Trial (CSPPT) and analyzed the fasting serum LDL-C and folate, and CIMT data obtained at the last follow-up visit. LDL-C was calculated using the Friedewald equation. Serum folate levels were measured by chemiluminescent immunoassay. CIMT was measured by ultrasound. Non-parametric smoothing plots, multivariate linear regression analysis, subgroup analyses and interaction testing were performed to examine the LDL-C–CIMI relationship and effect modification by folate. Consistent with graphic plots, multivariate linear regression showed that LDL-C levels were independently and positively associated with CIMT (β = 7.69, 95%CI: 5.76–9.62). More importantly, the relationship between LDL-C and CIMT was significantly attenuated with increasing serum folate levels (1st tertile: β = 10.06, 95%CI: 6.67–13.46; 2nd tertile: β = 6.81, 95%CI: 3.55–10.07; 3rd tertile: β = 5.96, 95%CI: 2.55–9.36; P-interaction = 0.045). Subgroup analyses showed the association between LDL-C and CIMT across serum folate tertiles was robust among various strata (all P-interaction >0.05).ConclusionsAmong Chinese hypertensive adults, the serum folate levels could modify the association between LDL-C and CIMT. Our findings, if further confirmed, have important clinical implications.     

2型糖尿病伴血脂异常患者HDL-C与内皮依赖性血管舒张功能的关系

目的探讨2型糖尿病（T2DM）血脂异常患者HDL-C对血管并发症的保护作用。方法选择无血管并发症的T2DM并血脂异常患者48例,根据HDL-C水平将T2DM患者分为两组：正常HDL组（HDL-C≥1.04mmol/L）和低HDL组（HDL-C〈1.04mmol/L）。同期,选择26例健康个体作为对照。采用高分辨血管外超声法检测肱动脉血流介导的内皮依赖性血管舒张功能（EDD）和硝酸甘油介导的内皮非依赖性血管舒张功能。结果（1）与对照组相比,正常HDL组和低HDL组BMI、FPG、2hPG、TC、TG、LDL-C明显高于对照组（P〈0.05～0.01）。低HDL组HDL-C明显低于对照组及正常HDL组（P〈0.01）,而正常HDL组HDL-C水平又低于对照组（P〈0.05）。（2）与对照组相比,正常HDL组和低HDL组EDD明显降低（P〈0.01）。与正常HDL组相比,低HDL组EDD明显降低（P〈0.01）。（3）多元线性相关分析表明,年龄、FPG、2hPG、LDL-C、HDL-C与EDD相关（P〈0.05）。结论在T2DM患者中,HDL-C对早期血管并发症具有保护作用。     

Impact of low-density lipoprotein cholesterol on cardiovascular outcomes in people with type 2 diabetes: A meta-analysis of prospective cohort studies

Aims

To estimate the prospective association of low-density lipoprotein (LDL) cholesterol on cardiovascular disease (CVD) risk among people with type 2 diabetes.

Methods

We used extensive literature searching strategies to locate prospective cohort studies that reported LDL cholesterol levels as a risk factor for cardiovascular events. We conducted meta-analytic procedures for two outcomes: incident CVD and CVD mortality.

Results

A total of 16 studies were included in this analysis with a mean follow-up range of 4.8–11 years. The pooled relative risk associated with a 1 mmol/L increase in LDL cholesterol in people with type 2 diabetes was 1.30 (95% confidence interval [CI], 1.19–1.43) for incident CVD, and 1.50 (95% CI, 1.25–1.80) for CVD mortality, respectively. Subgroup analyses showed that for incident CVD, the pooled relative risk was 1.28 (95% CI, 1.17–1.41) for 7 studies adjusted for blood pressure and/or glucose concentration (or insulin concentration, glycated hemoglobin) and 1.40 (95% CI, 1.05–1.86) for 3 studies that did not adjust for these variables.

Conclusions

Our study demonstrates that LDL cholesterol was associated with an increased risk for cardiovascular outcomes in people with type 2 diabetes, independent of other conventional risk factor.     

Comparison of gemfibrozil and lovastatin in patients with high low-density lipoprotein and low high-density lipoprotein cholesterol levels.

BACKGROUND--The efficacy of gemfibrozil and lovastatin in the treatment of patients who have an elevated low-density lipoprotein cholesterol (LDL-C) level and a low high-density lipoprotein cholesterol (HDL-C) level was compared. METHODS--After at least 6 weeks of a cholestgerol-lowering diet, 17 patients who had a mean baseline LDL-C level above 4.14 mmol/L (160 mg/dL) and an HDL-C level below 1.03 mmol/L (40 mg/dL) received gemfibrozil 600 mg twice daily and lovastatin 20 mg twice daily each for 6 weeks according to a randomized, crossover, double-blind research design. RESULTS--Lovastatin and gemfibrozil reduced LDL-C levels 34% and 9% and raised HDL-C levels 15% and 18%, respectively. CONCLUSIONS--Lovastatin is more effective in lowering LDL-C levels and is as effective as gemfibrozil in increasing HDL-C levels in these patients.     

Alteration in serum oxidative stress balance in patients with different circulating high-density lipoprotein cholesterol levels

Introduction and ObjectivesHigh-density lipoprotein cholesterol (HDL-C) is known to be a key player in reverse cholesterol transport and this function is associated with its atheroprotective role. Low HDL-C is a strong independent risk factor for cardiovascular disease, premature atherosclerosis and increased oxidative stress. However, the clinical benefit of high HDL-C through diet or drug therapy is still controversial.MethodsThis study included 50 patients with isolated low HDL-C (≤35 mg/dl), 52 patients with isolated high HDL-C (≥70 mg/dl), and 33 age- and gender-matched controls with normal HDL-C. ‘Isolated’ was defined as excluding all clinical conditions associated with increased oxidative stress and inflammation, which may affect the structural state of HDL-C. In addition to arylesterase (ARES) activity and plasma thiol levels, laboratory parameters associated with oxidative stress were also assessed.ResultsLevels of ARES (758 [169-1150] vs. 945 [480-1215] and 821 U/l [266-1220]; p<0.01) and total thiols (233±41 vs. 259±46 μmol/l; p=0.02) were markedly higher in patients with high HDL-C. More importantly, total antioxidant capacity, oxidative stress index, creatine and serum ARES levels were associated with changes in serum HDL-C levels.ConclusionIn patients with isolated high HDL-C, we determined that while serum ARES activity and plasma thiol concentrations were significantly higher, the other markers associated with oxidative stress decreased markedly. Additionally, the present study demonstrated that serum oxidative stress status is very important to maintain the positive effects of HDL-C.     

急性冠状动脉综合征患者基线C反应蛋白和低密度脂蛋白水平对其急性期预后的意义

目的分析基线高敏C反应蛋白（hs—CRP）和低密度脂蛋白胆固醇（LDL—C）水平与不同急性冠状动脉综合征（ACS）急性期预后的相关性及意义。方法连续入选172例ACS患者,入院24h内测定患者基线状态的hs—CRP和LDL—C水平,对所有患者随访30d,记录任何原因死亡、心血管事件（事件）发生次数和时间。按出现死亡、事件和无事件对患者进行分组,分析和比较三组患者基线hs—CRP、LDL～C和hs—CRP／LDL—C。应用Logistic回归分析包括年龄,治疗前、后血肌酐（Cr）水平等共19项危险因素对死亡率和事件发生率的影响。结果单因素分析显示,三组ACS患者基线LDL—C水平差异无统计学意义,死亡患者的LDL—C有更低的倾向。死亡患者的hs—CRP是无“事件”患者的13．0倍,是单纯有“事件”患者的5．5倍,差异有统计学意义。结论基线hs—CRP是ACS患者急性期死亡和心血管事件的非独立危险因素,基线LDL—C与急性预后不相关。hs—CRP可作为急性期治疗的靶目标。     

A comparative study with rosuvastatin in subjects with metabolic syndrome: results of the COMETS study.

AIMS: The efficacy and safety of rosuvastatin, atorvastatin, and placebo were compared in patients with the metabolic syndrome. METHODS AND RESULTS: Patients with the metabolic syndrome with low-density lipoprotein cholesterol (LDL-C) > or =3.36 mmol/L (130 mg/dL) and multiple risk factors conferring a 10-year coronary heart disease risk score of >10% were randomized (2:2:1) to receive rosuvastatin 10 mg, atorvastatin 10 mg, or placebo for 6 weeks. Subsequently, the rosuvastatin 10 mg and placebo groups received rosuvastatin 20 mg and the atorvastatin 10 mg group received atorvastatin 20 mg for 6 weeks. LDL-C was reduced significantly more in patients receiving rosuvastatin 10 mg when compared with those receiving atorvastatin 10 mg at 6 weeks [intention-to-treat (ITT) population by randomized treatment: 41.7 vs. 35.7%, P < 0.001; ITT population by as-allocated treatment: 42.7 vs. 36.6%, P < 0.001]. Significant LDL-C reductions were also observed in patients receiving rosuvastatin when compared with those receiving atorvastatin at 12 weeks (48.9 vs. 42.5%, P < 0.001). More patients achieved LDL-C goals with rosuvastatin when compared with atorvastatin. Rosuvastatin increased high-density lipoprotein cholesterol significantly more than atorvastatin. Treatments were well tolerated. CONCLUSION: At equivalent doses, rosuvastatin had a significantly greater effect than atorvastatin in lowering LDL-C and improving the lipid profile and was well tolerated in patients with the metabolic syndrome.     

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.