Lipid ratios and appropriate cut off values for prediction of diabetes: a cohort of Iranian men and women

Abstract

BackgroundDyslipidemia is a risk factor for incident type 2 diabetes; however, no study has specifically assessed the lipid ratios (i.e. total cholesterol (TC)/high density lipoprotein cholesterol (HDL-C) and triglyceride (TG)/HDL-C) as predictors of diabetes. We aimed to compare the independent association between the different lipid measures with incident diabetes over a median follow up of 6.4 years in Iranian men and women.MethodThe study population consisted of 5201 non diabetic (men = 2173, women = 3028) subjects, aged ≥20 years. The risk factor adjusted odds ratios (ORs) for diabetes were calculated for every 1 standard deviation (SD) change in TC, log-transformed TG, HDL-C, non-HDL-C, TC/HDL-C and log-transformed TG/HDL-C using multivariate logistic regression analysis. Receiver operator characteristic (ROC) curve analysis was used to define the points of the maximum sum of sensitivity and specificity (MAXss) of each lipid measure as a predictor of diabetes.ResultWe found 366 (146 men and 220 women) new diabetes cases during follow-up. The risk-factor-adjusted ORs for a 1 SD increase in TG, TC/HDL-C and TG/HDL-C were 1.23, 1.27 and 1.25 in men; the corresponding risks in females were 1.36, 1.14, 1.39 respectively (all p < 0.05, except TC/HDL-C in females which was marginally significant, p = 0.07). A 1 SD increase of HDL-C only in women decreased the risk of diabetes by 25% [0.75(0.64-0.89)]. In both genders, there was no difference in the discriminatory power of different lipid measures to predict incident diabetes in the risk factor adjusted models (ROC ≈ 82%). TG cutoff values of 1.98 and 1.66 mmol/l; TG/HDL-C cutoff values of 4.7 and 3.7, in men and women, respectively, TC/HDL-C cutoff value of 5.3 in both genders and HDL-C cutoff value of 1.18 mmol/l in women yielded the MAXss for defining the incidence of diabetes.ConclusionTC/HDL-C and TG/HDL-C showed similar performance for diabetes prediction in men population however; among women TG/HDL-C highlighted higher risk than did TC/HDL-C, although there was no difference in discriminatory power. Importantly, HDL-C had a protective effect for incident diabetes only among women.

Non‐high‐density lipoprotein cholesterol is more informative than traditional cholesterol indices in predicting diabetes risk for women with normal glucose tolerance

“…In recent decades, non‐HDL has been highlighted as an important secondary therapeutic goal in the management of dyslipidemia 9, 10. In contrast with the well acknowledged potent role of non‐HDL in predicting cardiovascular diseases,7, 23 previous studies that focused on the association between non‐HDL and development of diabetes arrived at contrary conclusions 11, 13. Furthermore, there is only one study that investigated the utility of non‐HDL in assessing incident type 2 diabetes risk in people who are relatively insulin‐sensitive and at low risk for diabetes 12.…”

“…Subsequently, a retrospective study further validated the superior role of non‐HDL in predicting diabetes in people with normal glucose tolerance (NGT) 12. On the contrary, there is also a study that observed no solid association between non‐HDL and the development of diabetes 13. Therefore, a well‐designed prospective study with a larger sample size is still imperative to elucidate the role of non‐HDL in predicting incident diabetes for people with NGT.…”

Triglycerides and triglycerides to high-density lipoprotein cholesterol ratio are strong predictors of incident hypertension in Middle Eastern women

“…5 Recently we showed that dyslipidemia is commonly associated with diabetes and CVD events among Iranian populations. 6,7 Dyslipidemia could lead to hypertension by mechanisms such as endothelial dysfunction resulting in impaired nitric oxide production, release and activity, and structural changes in large arteries following atherosclerosis. 8,9 Additionally, hypertension and dyslipidemia, as the components of metabolic syndrome may have universal mechanistic pathways.…”

The predictive role of serum triglyceride to high-density lipoprotein cholesterol ratio according to renal function in patients with acute myocardial infarction

“…Lastly, insulin resistance may be a cause of pathology. The TG/HDL-C ratio is also known as an acknowledged marker of insulin resistance [18][19][20]. Razani et al [21] reported that insulin resistance was an important contributor to the acceleration of atherogenesis.…”