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

doi:10.1016/j.hlc.2019.03.019

Heart, Lung and Circulation

Volume 29, Issue 3, March 2020, Pages 414-421

https://doi.org/10.1016/j.hlc.2019.03.019 Get rights and content

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.

Introduction

Cardiovascular disease (CVD) is the leading cause of mortality and morbidity globally. The clinical utility of hypertriglyceridaemia to independently predict the development of primary coronary artery disease (CAD) has been previously established [1], [2]. Patients with hypertriglyceridaemia undergoing coronary angiography have more severe CAD [3]. Similarly, low high-density lipoprotein cholesterol (HDL-C) level is strongly associated with CVD development and CVD-related mortality [4]. Moreover, elevated plasma triglycerides (TG) to HDL-C (TG/HDL-C) ratio has been studied as a surrogate biomarker to identify individuals with adverse cardiometabolic risk profiles [5].

Elevated TG/HDL-C ratio has been shown to be associated with adverse long-term cardiovascular outcomes and all-cause mortality in high-risk populations presenting for clinically indicated coronary angiography [6], [7], [8]. However, these studies were limited by gender-specific populations or those presenting with acute coronary syndromes [6], [7], [8]. Our study aims to evaluate the prognostic utility of elevated TG/HDL-C levels in an Australian population of patients with a high clinical suspicion of CAD presenting for coronary angiography.

Section snippets

Study Population

The study population was identified from the Biomarkers of Atherosclerosis, Vascular and Endothelial Dysfunction in Heart Disease (BRAVEHEART) Study. This was a single-centre, prospective cohort study that included patients presenting for coronary angiography/percutaneous coronary intervention (PCI) between October 2009 and May 2013 at St Vincent’s Hospital Melbourne, Australia. Patients with either recent or untreated malignancies, systemic inflammatory conditions, acute or chronic infections

Baseline Characteristics

A total of 482 patients were included in the study after 40 patients were lost during follow-up. The mean follow-up period was 5.1 ± 1.2 years. The mean age was 63.4 ± 11.0 years, 69% were males, 31% were females, 74.7% had hypertension, 80.6% had hypercholesterolaemia, 29.6% had diabetes, 32.9% had a history of previous AMI and 69.4% had a history of smoking (20.1% active smokers; 49.25% ex-smokers). 70.8% of the patients had CAD that was either diagnosed at angiography or had previous PCI for

Discussion

The principle objective of this study was to investigate the prognostic utility of elevated TG/HDL-C ratio in patients presenting for clinically indicated coronary angiography. This study found that, after adjusting for established cardiovascular risk factors and CAD on coronary angiography, elevated TG/HDL-C ratio is an independent predictor of long-term all-cause mortality and is strongly associated with long-term risk of MACE in patients presenting for coronary angiography.

The relationship

Acknowledgment

Andrew M. Wilson is supported by grants from the National Heart Foundation of Australia, Diabetes Australia Research Trust and the Australian Catholic University (Melbourne, Victoria, Australia). Arul Baradi is supported by an Australian Government Research Training Program Scholarship and NHMRC Centre of Research Excellence in Cardiovascular Outcomes Improvement (CRE-COI) PhD Scholarship (Melbourne, Victoria, Australia).

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Citation Excerpt :
Our data also demonstrated that overweight elderly have the highest TGL/HDL ratio (Table 2), which may be a possible marker to predict the increased risk of T2DM and SAH associated with body composition. A high proportion of TGL/HDL has been used to predict results in patients with adverse cardiometabolic risk profiles (Sultani et al., 2020). Plasma triglycerides may be some acute phase reagents, indicating disseminated endothelial damage, inflammation, fibrosis, and accelerated atherosclerosis with possible endogenous organ insufficiencies throughout the body.
Age-related changes in the body's physiological responses play a critical role in systemic arterial hypertension (SAH) and type 2 Diabetes mellitus (T2DM). SAH and T2DM have clinically silent low-grade inflammation as a common risk factor. This inflammation has a relevant element, the excess of fatty tissue. In this scenario, little is known about how inflammatory markers interact with each other. Therefore, this work evaluated the interplay among anthropometric, biochemical, and inflammatory markers in the elderly with SAH and T2DM. Men aged 60–80 years old with SAH and T2DM were classified by body mass index (BMI) as eutrophic elderly (EE, 24 individuals) or overweight elderly (OE, 25 individuals). Body composition analysis was performed using bioimpedance. Blood samples were collected to perform inflammatory and biochemical evaluations. The cytokines IL-17A, IL-1β, IFN-y, TNF-α, and IL-10, were evaluated by ELISA. Triglycerides, total and fractions of cholesterol, and glucose were measured by spectrophotometry. Overweight elderly men had a higher glycemic index and an increase in most anthropometric markers, as well as higher means for all pro-inflammatory cytokines analyzed (IL-17A, IL-1β, IFN-y, and TNF-α) in comparison to their eutrophic elderly counterparts. However, there was a decrease in IL-10 anti-inflammatory cytokine and IL-10/IL-17A ratio compared to their eutrophic elderly counterparts. Although overweight elderly men have worsening inflammatory parameters, the magnitude of their correlations with anthropometric and biochemical parameters becomes less evident. The Bayesian networks highlight that in the eutrophic elderly, IL-17A and TNF-α are the cytokines most associated with interactions, and most of these interactions occur with biochemical parameters. It is worth highlighting the role of IFN-y in overweight elderly men. This cytokine influences IL-10 and TNF-α production, contributing to the inflammatory profile exacerbated in this group.
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Original ArticleElevated Triglycerides to High-Density Lipoprotein Cholesterol (TG/HDL-C) Ratio Predicts Long-Term Mortality in High-Risk Patients

Background

Methods

Results

Conclusions

Introduction

Section snippets

Study Population

Baseline Characteristics

Discussion

Acknowledgment

Am J Cardiol

Am Heart J

Int J Cardiol

Am J Cardiol

Am J Cardiol

Atherosclerosis

Clin Biochem

Pediatr Diab

Nutr Metab Cardiovasc Dis: NMCD

The independent relationship between triglycerides and coronary heart disease

Vasc Health Risk Manag

High triglyceride level is associated with severe coronary artery disease in hypertensive subjects

Scand Cardiovasc J

High-density lipoprotein cholesterol, coronary artery disease, and cardiovascular mortality

Eur Heart J

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

The association between triglyceride/high-density lipoprotein cholesterol ratio and all-cause mortality in acute coronary syndrome after coronary revascularization

PLoS One

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

How do elevated triglycerides and low HDL-cholesterol affect inflammation and atherothrombosis?

Current Cardiol Rep

Importance of different pathways of cellular cholesterol efflux

Arterioscler Thromb Vasc Biol

Identification of scavenger receptor SR-BI as a high density lipoprotein receptor

Science

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