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Triglyceride/hdl Ratio Prediction For Cardiovascular Disease

Predictive Value Of The Triglyceride To High

More Important than LDL Cholesterol? The TG/HDL Ratio (Part 1)
  • Department of Cardiology, Tianjin Chest Hospital, Tianjin, China

Background and Aims: Studies have highlighted the role of the triglyceride to high-density lipoprotein cholesterol ratio on subsequent cardiovascular events. However, the association of the TG/HDL-C ratio with survival outcomes in diabetic patients with coronary artery disease treated with statins remains unknown. This study aimed to assess the predictive value of the TG/HDL-C ratio for all-cause mortality and cardiovascular death in diabetic patients with CAD treated with statins.

Methods: The data of patients with type 2 diabetes and angiographically-confirmed CAD who were undergoing statin therapy and visited Tianjin Chest Hospital between January 2016 and September 2016 were retrospectively collected. The patients were categorized based on the baseline TG/HDL-C ratio tertile. Kaplan-Meier analysis and multivariate Cox proportional hazard regression were applied to assess the role of the TG/HDL-C ratio in predicting all-cause mortality and cardiovascular death.

TG/HDL-C ratio might be useful for predicting all-cause mortality and cardiovascular death in diabetic patients with CAD treated with statins.

Data Collection And Definitions

Baseline demographic characteristics, clinical presentation, cardiac function, extent of lesion, treatment strategy, laboratory findings at fasting status, and medication data at discharge were collected from medical records and the data managers were blinded to the study purpose. The demographic characteristics included age sex ratio duration of diabetes smoker proportion hypertension prior myocardial infarction , percutaneous coronary intervention , coronary artery bypass graft , or stroke and body mass index . The cardiac function included left ventricle ejection fraction . The clinical presentation included SAP and ACS, and the extent of lesion included left main disease and multi-vessel disease . The treatment strategies included medical therapy, PCI, and CABG. Laboratory findings included fasting plasma glucose , hemoglobin A1c , total cholesterol , TG, low-density lipoprotein cholesterol , HDL-C, the TG/HDL-C ratio, serum uric acid, high-sensitivity C-reactive protein , and estimated glomerular filtration rate . The medications at discharge included aspirin, clopidogrel/ticagrelor, -blocker, angiotensin II coenzyme inhibitor or angiotensin II receptor blocker , calcium channel blocker , nitrate, and insulin.

The Triglyceride/ Hdl Ratio

The triglyceride/HDL ratio is one test, and both are components of the lipid profile. Lipid profiles are routinely ordered to check for total cholesterol, LDL, HDL, and triglycerides levels.

The triglyceride/HDL ratio is the value of the triglyceride divided by the HDL.

A study compared the Triglyceride/HDL ratio among different racial and ethnic groups in the US. The study compared the triglyceride/HDL ratio and fasting insulin. Fasting insulin is another measure of insulin resistance.

In the study , TG/HDL 3.5 correlates with insulin resistance across three BMI categories and three ethnic groups, namely the non-Hispanic whites, non-Hispanic blacks, and Mexican Americans.

The optimal cut-off point of the TG/HDL-C ratio for predicting insulin resistance and hyperinsulinemia was 3.0 for non-Hispanic whites and Mexican Americans and 2.0 for non-Hispanic blacks.

The TG/HDL-C ratio with hyperinsulinemia was stronger among people with a BMI < 25 kg/m2 than those with a BMI 30 kg/m2. The significance of that finding is early detection. High triglyceride levels happen first before excess visceral fat or obesity if obvious. Some people with high triglycerides may not even be obese.

The use of that high TG/HDL to dete4c insulin resistance in the non-obese will be duplicated in children and proven with another study below.

Recommended Reading: What Does It Mean If Your Hdl Cholesterol Is High

Does Ethnicity Matter In Terms Of Tg/hdl

TG/HDL appears to vary by ethnicity. Ratios are higher in Hispanic Americans than non-Hispanic whites and non-Hispanic Blacks .

Thus, many say that we should go target different levels based upon ethnicity. Those same scientists have said that a TG/HDL of 2.0 is diagnostic of prediabetes for African-Americans.

Although the patterns of TG/HDL vary by ethnicity, I do not recommend focusing on this. There are several reasons, such as the fact that ethnicities are often mixed and unknown.

But the biggest reason is that TG/HDL is an indicator of the health of insulin and glucose metabolismthe lower the ratio, the better the patients health. Not to mention that most of the cut points used in research as markers for prediabetes are too high. For example, ratios of 2 and 3 confer risk, no matter what your ethnicity is.

A TG/HDL of 3 confers a higher risk for heart disease, so all of us should focus on this important number. No matter which ethnicity, the goal should be as low as possible. Like I mentioned in the previous section, I do recommend that my patients target 1.5 or less.

The Triglyceride Paradox In The Black Community


As I mentioned above, in populations of African descent, elevated TGs arent present even when insulin resistance is. What we see instead is normal triglycerides and low HDL-C. As such, low HDL-C can be one sign of insulin resistance in African Americans, and the usual diagnostic tests used to identify insulin resistance may leave cases of metabolic problems hidden in these communities.

For more, see the excellent write up in the Journal of Metabolic Syndrome and Related Disorders titled The Triglyceride Paradox in People of African Descent.

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The Pros And Cons Of Total Cholesterol Hdl Ldl And Triglyceride Testing

Time to get your cholesterol checked. Okay, but which test should you get? Its not so simple anymore. Here is a rundown of some of the choices and their pros and cons:

Total cholesterol. This is the simplest and least expensive test. The test doesnt require any sophisticated lab work, either. The simple, do-it-yourself home cholesterol tests measure total cholesterol.

But total cholesterol includes both good high-density lipoprotein cholesterol, and the bad varieties, chiefly low-density lipoprotein and very-low-density lipoprotein . So, if your total cholesterol is in the desirable category, its possible that you may have unhealthy levels of HDL and LDL and VLDL . Think of total cholesterol as a first glimpse, a peek. Doctors are not supposed to make any treatment decisions based on this number alone.

Cholesterol levels can be lowered by stress or infection. An injury, cancer, stroke, or heart attack may have the same effect. So, if your cholesterol levels are unusually high or low, your doctor will probably want to repeat the test some weeks later. Abnormal readings may also lead to tests for other medical problems.

HDL cholesterol. HDL wins its laurels as the good cholesterol because it sponges up cholesterol from blood vessel walls and ferries it to the liver for disposal. In contrast, LDL deposits the harmful fat in vessel walls.

An HDL level of 60 or above is associated with a lower risk of heart disease, and below 40 is associated with a higher risk.

How To Lower Your Cholesterol

If you are wondering what to do about your cholesterol, follow these rules:

  • Get regular aerobic physical exercise. It has been proven that regular exercises increase HDL cholesterol and decrease LDL cholesterol . Moreover, it may also lower your risk of heart attack or stroke, as it reduces the blood pressure.

  • Diet. Eat foods low in fatty acids, saturated fats, and cholesterol. Dont forget to include in your diet fish, as they are a source of omega-3 fatty acids. Consider eating cholesterol-lowering foods, such as margarine, enriched with plant sterols and stanols.

  • Use medications. If the non-pharmacological ways of treatment dont bring satisfactory results, dont hesitate to contact your doctor, who may propose drug therapies. There are numerous drugs that doctors can use to lower your bad cholesterol and correct your LDL HDL ratio. It has been scientifically proven that they not only lower cholesterol but also and prolong life.

  • Dont be afraid to make valuable changes in your life. Calculate your LDL HDL ratio and other ratios using our cholesterol ratio calculator. Lower your cholesterol, treat hypertension and diabetes, check for abnormalities in your ECG, protect your heart and live healthier, longer, and happier!

    Read Also: Will Eating 2 Eggs A Day Raise My Cholesterol

    Triglyceride/hdl Cholesterol Ratio And Insulin Resistance

    Insulin resistance is a condition in which cells fail to respond to the normal actions of insulin. Most people with this condition have high levels of insulin in their blood. Insulin resistance appears to play a significant role in coronary heart disease and can predict mortality. The condition is common among individuals with abdominal obesity and the metabolic syndrome.

    A study in which most of the participants were Caucasian and overweight identified TG/HDL-C ratio of 3 or greater as a reliable predictor of insulin resistance.

    However, not all studies have found the TG/HDL-C ratio to be associated with insulin resistance. For example, in a relatively small study of 125 African American participants, neither fasting TG nor the TG/HDL-C ratio was shown to be a marker of insulin resistance.

    Although confirmatory studies are needed, data suggests that an elevated TG/HDL-C ratio may be clinically useful for the prediction of insulin resistance.

    Characteristics Of The Subjects

    Triglyceride & Remnant Cholesterol (Part 1) – Why We Get Fat

    Table shows the characteristics of the male and female subjects. Variables related to cardiovascular disease were significantly higher in men than in women except for HDL cholesterol, which was significantly higher in women than in men. There were 310 men and 54 women who showed accumulation of three cardiovascular risk factors .

    Table 2 Characteristics of the subjects

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    Tg/hdl Ratio In The Black Community

    Much of the conversation surrounding the health benefits of TG/HDL ratio centers on studies, like the Framingham study, which focused overwhelmingly on Caucasian populations.

    The TG/HDL means very little for African Americans because African Americans generally have lower levels of triglycerides, and unlike White populations, this holds true even in the presence of insulin resistance.

    Why Is It Important To Measure Your Cholesterol Level Periodically

    • If you are over the age of 30 years, take a lipid profile test regularly to know your cholesterol levels for necessary lifestyle changes and medication, if necessary.
    • You should check your cholesterol every year if you are taking medicine to control your cholesterol levels, or if you have been diagnosed with diabetes, heart disease or high blood pressure.
    • If you have a family history of heart disease, cholesterol test is recommended every 5 years, beginning at the age of 20 years.
    * All values are in milligram/decilitre

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    Triglyceride/hdl To Detect Insulin Resistance In Children

    In children 5-18 years old, a study from Turkey found that TG/HDL ratio was significantly higher in patients who had insulin resistance and fatty liver than in those who did not. There was no significant difference in TG/HDL ratio between female-male, prepubertal-pubertal, and overweight/obese patients. There was no correlation between age, body mass index standard deviation score , and TG/HDL ratio.

    Again, this study shows that insulin resistance and fatty liver can be detected in children even before becoming obese.

    The next part will show the TG/HDL ratio in predicting diseases.

    What Is Total Cholesterol


    When your cholesterol is checked, you get a number for total cholesterol, one for the HDL level, and one for the LDL level. Your total cholesterol will be more than the sum of the HDL and LDL numbers.

    Either a high HDL number or a high LDL number can make your total cholesterol number high. If its high because of a high HDL number, your health is not necessarily in danger. However, if its high because your LDL cholesterol level is high, its important to talk with your doctor about your health .

    Also Check: What Is Low Hdl Cholesterol

    Recommended Reading: Does Saturated Fat Affect Cholesterol

    Ethics Approval And Consent To Participate

    The authors state that this study complies with the Declaration of Helsinki, that the research protocol has been approved by the Ethics Committee of the coordinating center and by the locally appointed Ethics Committees of the participating centers, and that informed consent has been obtained from the subjects .

    Publicacin Continuada Como Endocrinologa Diabetes Y Nutricin Ms Informacin

    Index Medicus/MEDLINE, Excerpta Medica/EMBASE, SCOPUS, Science Citation Index Expanded, Journal Citation Reports/Science Edition, IBECS


    SJR es una prestigiosa métrica basada en la idea de que todas las citaciones no son iguales. SJR usa un algoritmo similar al page rank de Google es una medida cuantitativa y cualitativa al impacto de una publicación.

    SNIP permite comparar el impacto de revistas de diferentes campos temáticos, corrigiendo las diferencias en la probabilidad de ser citado que existe entre revistas de distintas materias.

    The triglyceride/HDL cholesterol ratio, as a surrogate marker of insulin resistance, may be associated to presence of subclinical carotid atherosclerosis in postmenopausal women. The aim of this study was to explore this association.

    Women in primary prevention up to 65 years of age were recruited. Association between the triglyceride/HDL cholesterol ratio and presence of carotid plaque, assessed by ultrasonography, was analyzed. ROC analysis was performed, determining the precision of this ratio to detect carotid plaque.

    In postmenopausal women in primary prevention, insulin resistance, estimated from the triglyceride/HDL-C ratio, was independently associated to a greater probability of carotid plaque. A value of such ratio greater than 2 may be used for assessing cardiovascular risk in this particular group of women.

    The inclusion criteria were: women aged65 years with 2 years since their last menstrual period.

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    The Triglyceride/hdl Cholesterol Ratio

    Estimated reading time: 7 minutes

    For years, measurements of blood cholesterol have been used to assess the risk of heart disease.

    We have been intensively educated about the role of LDL-cholesterol , commonly nicknamed the bad cholesterol and HDL-cholesterol , often called the good cholesterol.

    For many different reasons, lowering LDL-C has become a primary goal in cardiovascular prevention. There is substantial evidence available suggesting a relationship between LDL-C and the risk of coronary heart disease.

    Medical professionals usually recommend lifestyle measures that lower LDL-C and statins are used by millions of people worldwide for the sole purpose of lowering LDL-C numbers.

    However, to understand coronary heart disease and how plaques form in our arteries we have to understand that focusing only on cholesterol is an oversimplification.

    Because cholesterol is a fat substance, it cant mix with water and can therefore not travel in blood on its own. The bodys solution to this problem is to bind fat molecules to lipoproteins that function as transport vehicles carrying different types of fats such as cholesterol, triglycerides and phospholipids.

    It is important to understand that it is lipoproteins that interact with the arterial wall and initiate the development of atherosclerosis. Cholesterol is only one of many components of lipoproteins.

    Baseline Clinical Characteristics Of The Study Population

    Knowing this ratio will save you from a Heart Attack: Triglyceride/HDL Ratio

    In the overall study population, the mean value of TG/HDL ratio was 2.78±2.37 and the median value was 2.095 . Demographic and clinical characteristics, cardiovascular risk factors and medication use are detailed in Table . In the whole population, mean age was 60±9 years and 59% of patients were men. Family history of CAD was present in 33% of patients and the majority of the population had atypical chest pain , hypercholesterolemia and hypertension . Diabetes was diagnosed in 112 and metabolic syndrome in 118 patients. In the different TG/HDL ratio quartiles, the frequency of male gender, diabetes, smoking habit and of the metabolic syndrome significantly increased from the I quartile to the IV quartile. Male patients and patients with diabetes, obesity and metabolic syndrome showed significantly higher TG/HDL ratio as compared with female patients or patients without diabetes, obesity and the metabolic syndrome, respectively . A significant increase across quartiles was found for BMI, the use of beta-blockers, diuretics and glucose-lowering agents.

    Table 1 Clinical characteristics of the study population and of groups defined by TG/HDL-C quartiles. .

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    How To Improve Your Triglyceride/hdl Cholesterol Ratio

    Improving your TG/HDL ratio aims at lowering TG, raising HDL-C or preferably both.

    If you are overweight, losing weight will probably lower your TG levels and so will reducing your intake of added sugar. Studies have found that high intake of fructose leads to high TG. High-fructose corn syrup is a major source of fructose.

    Low-fat diets are usually not effective in lowering TG. In fact, low-fat, high-carbohydrate diets may raise TG. Adding omega-3 fatty acids, regular exercise and limiting alcohol may be helpful to reduce TG.

    Similar methods may be useful for raising HDL-C. Losing weight, exercising and not smoking may help. In controlled trials, low-fat, high-carbohydrate diets decrease HDL-C, thereby raising theTG/HDL-C ratio.

    In 1961, a group of investigators from the Rockefeller Institute, led by Pete Ahrens published a paper entitled Carbohydrate-induced and fat-induced lipemia.

    The authors pointed out that fat-induced increase in TG following a meal is a postprandial phenomenon caused by chylomicrons is different from the carbohydrate-induced rise in TG .

    These findings have been confirmed in several more recent studies. Despite this, low fat, high carbohydrate diets are still being recommended as a primary option to reduce the risk of heart disease.

    Although low-fat diets may help to lower LDL-C, low-carbohydrate diets are more effective in improving the TG/HDL-C ratio.

    Total Cholesterol Hdl Ldl And Triglycerides

    Our cholesterol ratio calculator takes into account four basic blood test results. All of the recommended levels are taken from the National Heart, Lung, and Blood Institute within the National Institute of Health.

    You only need to input three of your results they are dependent on each other according to the formula:

    total cholesterol = HDL + LDL + 0.2 × triglycerides

  • Total cholesterol is just an overview of your cholesterol level. It might be misleading, as it combines good and bad cholesterol levels in your blood and does not give sufficient information about heart disease risks.

  • Desirable: Less than 200 mg/dL
  • Borderline high: 200-239 mg/dL
  • High: 240 mg/dL and above
  • HDL is the good cholesterol in your blood. Generally speaking, it is a form of cholesterol that is transferred from other parts of your body to the liver in order to metabolize it and remove it from the body with bile acids. Thats why this is the only cholesterol type that should be kept high. Women tend to have slightly higher HDL levels than men.

  • Optimal: 60 mg/dL and above
  • Borderline: 40-59 mg/dL
  • Risk of heart disease: Less than 40 mg/dL
  • Optimal: Less than 100 mg/dL
  • Near optimal/above optimal: 100-129 mg/dL
  • Borderline high: 130-159 mg/dL
  • Very high: 500 mg/dL or above
  • Recommended Reading: What To Eat If You Have High Cholesterol


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