Advertisement
Heart, Lung and Circulation

Elevated Triglycerides to High-Density Lipoprotein Cholesterol (TG/HDL-C) Ratio Predicts Long-Term Mortality in High-Risk Patients

Published:April 09, 2019DOI:https://doi.org/10.1016/j.hlc.2019.03.019

      Background

      Elevated triglycerides to high-density lipoprotein cholesterol (TG/HDL-C) ratio has been utilised as a predictor of outcomes in patients with adverse cardiometabolic risk profiles. In this study, we examined the prognostic value of elevated TG/HDL-C level in an Australian population of patients with high clinical suspicion of coronary artery disease (CAD) presenting for coronary angiography.

      Methods

      Follow-up data was collected for 482 patients who underwent coronary angiography in a prospective cohort study. The primary endpoint was all-cause mortality and the secondary endpoint was a major adverse cardiac event (MACE). Patients were stratified into two groups according to their baseline TG/HDL-C ratio, using a TG/HDL-C ratio cut point of 2.5.

      Results

      The mean follow-up period was 5.1 ± 1.2 years, with 49 all-cause deaths. Coronary artery disease on coronary angiography was more prevalent in patients with TG/HDL-C ratio ≥2.5 (83.6% vs. 69.4%, p = 0.03). On the Kaplan-Meier analysis, patients with TG/HDL-C ratio ≥2.5 had worse long-term prognosis (p = 0.04). On multivariate Cox regression adjusting for established cardiovascular risk factors and CAD on coronary angiography, TG/HDL-C ratio ≥2.5 was an independent predictor of long-term all-cause mortality (hazard ratio [HR] 2.10, 95% confidence interval [CI] 1.04–4.20, p = 0.04). On multivariate logistic regression adjusting for known cardiovascular risk factors and CAD on coronary angiography, TG/HDL-C ratio ≥2.5 was strongly associated with an increased risk of long-term MACE (odds ratio [OR] 2.72, 95% CI 1.42–5.20, p = 0.002).

      Conclusions

      Elevated TG/HDL-C ratio is an independent predictor of long-term all-cause mortality and is strongly associated with an increased risk of MACE.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Heart, Lung and Circulation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Morrison A.
        • Hokanson J.E.
        The independent relationship between triglycerides and coronary heart disease.
        Vasc Health Risk Manag. 2009; 5: 89-95
        • Cullen P.
        Evidence that triglycerides are an independent coronary heart disease risk factor.
        Am J Cardiol. 2000; 86: 943-949
        • Chen C.Y.
        • Hwu C.M.
        • Lin M.W.
        • Tsai C.H.
        • Yeh H.I.
        High triglyceride level is associated with severe coronary artery disease in hypertensive subjects.
        Scand Cardiovasc J. 2008; 42: 146-152
        • Silbernagel G.
        • Schottker B.
        • Appelbaum S.
        • Scharnagl H.
        • Kleber M.E.
        • Grammer T.B.
        • et al.
        High-density lipoprotein cholesterol, coronary artery disease, and cardiovascular mortality.
        Eur Heart J. 2013; 34: 3563-3571
        • Jeppesen J.
        • Hein H.O.
        • Suadicani P.
        • Gyntelberg F.
        Relation of high TG-low HDL cholesterol and LDL cholesterol to the incidence of ischemic heart disease. An 8-year follow-up in the Copenhagen Male Study.
        Arterioscler Thromb Vasc Biol. 1997; 17: 1114-1120
        • Bittner V.
        • Johnson B.D.
        • Zineh I.
        • Rogers W.J.
        • Vido D.
        • Marroquin O.C.
        • et al.
        The triglyceride/high-density lipoprotein cholesterol ratio predicts all-cause mortality in women with suspected myocardial ischemia: a report from the Women’s Ischemia Syndrome Evaluation (WISE).
        Am Heart J. 2009; 157: 548-555
        • Wan K.
        • Zhao J.
        • Huang H.
        • Zhang Q.
        • Chen X.
        • Zeng Z.
        • et al.
        The association between triglyceride/high-density lipoprotein cholesterol ratio and all-cause mortality in acute coronary syndrome after coronary revascularization.
        PLoS One. 2015; 10e0123521
        • Vega G.L.
        • Barlow C.E.
        • Grundy S.M.
        • Leonard D.
        • DeFina L.F.
        Triglyceride-to-high-density-lipoprotein-cholesterol ratio is an index of heart disease mortality and of incidence of type 2 diabetes mellitus in men.
        J Invest Med. 2014; 62: 345-349
        • Welty F.K.
        How do elevated triglycerides and low HDL-cholesterol affect inflammation and atherothrombosis?.
        Current Cardiol Rep. 2013; 15: 400
        • Yancey P.G.
        Importance of different pathways of cellular cholesterol efflux.
        Arterioscler Thromb Vasc Biol. 2003; 23: 712-719
        • Gadi R.
        • Amanullah A.
        • Figueredo V.M.
        HDL-C: does it matter? An update on novel HDL-directed pharmaco-therapeutic strategies.
        Int J Cardiol. 2013; 167: 646-655
        • Acton S.
        • Rigotti A.
        • Landschulz K.T.
        • Xu S.
        • Hobbs H.H.
        • Krieger M.
        Identification of scavenger receptor SR-BI as a high density lipoprotein receptor.
        Science. 1996; 271: 518-520
        • Steinberg D.
        A docking receptor for HDL cholesterol esters.
        Science. 1996; 271: 460
        • Kleber M.E.
        • Grammer T.B.
        • Marz W.
        High-density lipoprotein (HDL) and cholesteryl ester transfer protein (CETP): role in lipid metabolism and clinical meaning.
        MMW Fortschritte der Medizin. 2010; 152: 47-55
        • Klerkx A.H.
        • El Harchaoui K.
        • van der Steeg W.A.
        • Boekholdt S.M.
        • Stroes E.S.
        • Kastelein J.J.
        • et al.
        Cholesteryl ester transfer protein (CETP) inhibition beyond raising high-density lipoprotein cholesterol levels: pathways by which modulation of CETP activity may alter atherogenesis.
        Arterioscler Thromb Vasc Biol. 2006; 26: 706-715
        • Hewing B.
        • Fisher E.A.
        Rationale for cholesteryl ester transfer protein inhibition.
        Curr Opin Lipidol. 2012; 23: 372-376
        • McLaughlin T.
        • Abbasi F.
        • Cheal K.
        • Chu J.
        • Lamendola C.
        • Reaven G.
        Use of metabolic markers to identify overweight individuals who are insulin resistant.
        Ann Int Med. 2003; 139: 802-809
        • Cordero A.
        • Laclaustra M.
        • León M.
        • Casasnovas J.
        • Grima A.
        • Luengo E.
        • et al.
        Comparison of serum lipid values in subjects with and without the metabolic syndrome.
        Am J Cardiol. 2008; 102: 424-428
        • Bigazzi R.
        • Bianchi S.
        Insulin resistance, metabolic syndrome and endothelial dysfunction.
        J Nephrol. 2007; 20: 10-14
        • Sattar N.
        • Gaw A.
        • Scherbakova O.
        • Ford I.
        • O’Reilly D.S.
        • Haffner S.M.
        • et al.
        Metabolic syndrome with and without C-reactive protein as a predictor of coronary heart disease and diabetes in the West of Scotland coronary prevention study.
        Circulation. 2003; 108: 414-419
        • Schmidt C.
        • Bergstrom G.M.
        The metabolic syndrome predicts cardiovascular events: results of a 13-year follow-up in initially healthy 58-year-old men.
        Metab Syndr Relat Disord. 2012; 10: 394-399
        • McNeill A.M.
        • Rosamond W.D.
        • Girman C.J.
        • Golden S.H.
        • Schmidt M.I.
        • East H.E.
        • et al.
        The metabolic syndrome and 11-year risk of incident cardiovascular disease in the atherosclerosis risk in communities study.
        Diab Care. 2005; 28: 385-390
        • Hanak V.
        • Munoz J.
        • Teague J.
        • Stanley A.
        • Bittner V.
        Accuracy of the triglyceride to high-density lipoprotein cholesterol ratio for prediction of the low-density lipoprotein phenotype B.
        Am J Cardiol. 2004; 94: 219-222
        • Koba S.
        • Hirano T.
        • Ito Y.
        • Tsunoda F.
        • Yokota Y.
        • Ban Y.
        • et al.
        Significance of small dense low-density lipoprotein-cholesterol concentrations in relation to the severity of coronary heart diseases.
        Atherosclerosis. 2006; 189: 206-214
        • Dobiasova M.
        • Frohlich J.
        The plasma parameter log (TG/HDL-C) as an atherogenic index: correlation with lipoprotein particle size and esterification rate in apoB-lipoprotein-depleted plasma (FER(HDL)).
        Clin Biochem. 2001; 34: 583-588
        • de Giorgis T.
        • Marcovecchio M.L.
        • Di Giovanni I.
        • Giannini C.
        • Chiavaroli V.
        • Chiarelli F.
        • et al.
        Triglycerides-to-HDL ratio as a new marker of endothelial dysfunction in obese prepubertal children.
        Eur J Endocrinol/Eur Fed Endocr Soc. 2014; 170: 173-180
        • Li X.
        • Deng Y.P.
        • Yang M.
        • Wu Y.W.
        • Sun S.X.
        • Sun J.Z.
        Triglyceride to high-density lipoprotein cholesterol ratio and carotid intima-medial thickness in Chinese adolescents with newly diagnosed type 2 diabetes mellitus.
        Pediatr Diab. 2016; 17: 87-92
        • da Luz P.L.
        • Favarato D.
        • Faria-Neto Jr., J.R.
        • Lemos P.
        • Chagas A.C.
        High ratio of triglycerides to HDL-cholesterol predicts extensive coronary disease.
        Clin (Sao Paulo, Brazil). 2008; 63: 427-432
        • Yunke Z.
        • Guoping L.
        • Zhenyue C.
        Triglyceride-to-HDL cholesterol ratio. Predictive value for CHD severity and new-onset heart failure.
        Herz. 2014; 39: 105-110
        • Hadaegh F.
        • Khalili D.
        • Ghasemi A.
        • Tohidi M.
        • Sheikholeslami F.
        • Azizi F.
        Triglyceride/HDL-cholesterol ratio is an independent predictor for coronary heart disease in a population of Iranian men.
        Nutr Metab Cardiovasc Dis: NMCD. 2009; 19: 401-408
        • Gaziano J.M.
        • Hennekens C.H.
        • O’Donnell C.J.
        • Breslow J.L.
        • Buring J.E.
        Fasting triglycerides, high-density lipoprotein, and risk of myocardial infarction.
        Circulation. 1997; 96: 2520-2525
        • Asia Pacific Cohort Studies C
        A comparison of lipid variables as predictors of cardiovascular disease in the Asia Pacific Region.
        Ann Epidemiol. 2005; 15: 405-413
        • Jeppesen J.
        • Hein H.
        • Suadicani P.
        • Gyntelberg F.
        LOw triglycerides–high high-density lipoprotein cholesterol and risk of ischemic heart disease.
        Arc Internal Med. 2001; 161: 361-366
        • da Luz P.
        • Favarato D.
        • Faria Neto J.
        • Lemos P.
        • Chagas A.C.P.
        High ratio of triglycerides to HDL-cholesterol predicts extensive coronary disease.
        Clinics. 2008; 63: 427-432
        • Drexel H.
        • Aczel S.
        • Marte T.
        • Benzer W.
        • Langer P.
        • Moll W.
        • et al.
        Is Atherosclerosis in Diabetes and Impaired Fasting Glucose Driven by Elevated LDL Cholesterol or by Decreased HDL Cholesterol?.
        Diabe Care. 2005; 28: 101-107
      1. Effects of long-term fenofibrate therapy on cardiovascular events in 9795 people with type 2 diabetes mellitus (the FIELD study): randomised controlled trial.
        The Lancet. 2005; 366: 1849-1861