The Association between the Triglyceride to High-density Lipoprotein Cholesterol Ratio and Low-density Lipoprotein Subclasses

Front. Cardiovasc. Med.

et al. 2021

Background and Aims: Studies have highlighted the role of the triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio on subsequent cardiovascular events. However, the association of the TG/HDL-C ratio with survival outcomes in diabetic patients with coronary artery disease (CAD) 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.Results: A total of 2,080 patients were included. During the 4-year follow-up, 209 patients died, 136 of whom from cardiovascular death. The Kaplan-Meier analyses showed that an increased TG/HDL-C ratio was associated with an increased risk of all-cause mortality (P < 0.001) and cardiovascular death (P < 0.001). The multivariate cox hazard regression analysis revealed a similar effect of the TG/HDL-C ratio on the risk of all-cause mortality (P = 0.046) and cardiovascular death (P = 0.009). The role of the TG/HDL-C ratio in predicting all-cause mortality and cardiovascular death was similar among all subgroups (P > 0.050). For all-cause mortality, the TG/HDL-C ratio significantly improved the C-statistic from 0.799 to 0.812 (P = 0.018), and the net reclassification index (NRI) and integrated discrimination index (IDI) were 0.252 (95% CI: 0.112–0.392; P < 0.001) and 0.012 (95% CI: 0.003–0.022; P = 0.012), respectively. Similarly, for cardiovascular death, the TG/HDL-C ratio significantly improved the C-statistic from 0.771 to 0.804 (P < 0.001), and the NRI and IDI were 0.508 (95% CI: 0.335–0.680; P < 0.001) and 0.033 (95% CI: 0.015–0.050; P < 0.001).Conclusion: TG/HDL-C ratio might be useful for predicting all-cause mortality and cardiovascular death in diabetic patients with CAD treated with statins.

Section: Discussionmentioning

confidence: 99%

Predictive Value of the Triglyceride to High-Density Lipoprotein Cholesterol Ratio for All-Cause Mortality and Cardiovascular Death in Diabetic Patients With Coronary Artery Disease Treated With Statins

Front. Cardiovasc. Med.

et al. 2021

“…Elevated TG level and decreased HDL-C content may directly contribute to endothelial dysfunction and atherosclerosis. Furthermore, elevated TG/HDL-C ratio is positively associated with other atherogenic lipid phenotype, characterized by higher small dense LDL particles [14,60]along with higher remnant particle cholesterol and non-HDL-C [61]which contribute to progression of atherosclerosis. Second, elevated TG/HDL-C ratio is associated with worsening IR in patients with diabetes [15,16].…”

Section: Discussionmentioning

confidence: 99%

Triglyceride to high-density lipoprotein cholesterol ratio predicts all-cause and cardiovascular mortality in diabetic patients with coronary artery disease on statin treatment

et al. 2021

Preprint

Background The triglyceride (TG)to high-density lipoprotein cholesterol (HDL-C) ratio has been regarded as an independent predictor of cardiovascular events. However, the association of TG/HDL-C ratio with survival in patients with diabetes and coronary artery disease (CAD) on statin therapy remains uncertain. The aim of the present study was to explore whether TG/HDL-C ratio predicts mortality in diabetic patients with CAD on statin treatment. Methods A total of 2080 consecutive patients with type 2 diabetes and angiographic-proven CAD who were treated with statin were enrolled in the presents study. Patients were divided into tertiles according to baseline TG/HDL-C ratio. The primary endpoints were all-cause and cardiovascular mortality. Results During 4-year follow-up, 209(10.0%) patients died, 136(65.1%) caused by cardiovascular disease (CVD). The Kaplan-Meier analyses showed that all-cause and cardiovascular mortality increased gradually with rising TG/HDL-C ratio tertiles (log-rank test, P < 0.001, respectively). Multivariate cox hazard regression analysis revealed that patients in tertile 3 but not teretile 2 had significantly higher rate of all-cause and cardiovascular mortality (P < 0.001, P < 0.05, respectively). Moreover, TG/HDL-C ratio was independently associated with all-cause mortality (HR: 1.21, 95% CI:1.11–1.31; P < 0.001) and cardiovascular mortality (HR:1.28, 95% CI: 1.19–1.37; P < 0.001). For all-cause mortality, TG/HDL-C ratio significantly improved the C-statistic (0.799[0.766–0.833] to 0.813[0.780–0.845]; P = 0.018), net reclassification index (NRI) (0.315; P < 0.001), and integrated discrimination index (IDI) (0.012; P = 0.003). For cardiovascular mortality, TG/HDL-C ratio significantly improved the C-statistic (0.769[0.727–0.812] to 0.810[0.771–0.849]; P = 0.001), NRI (0.442; P < 0.001), and IDI (0.039; P < 0.001). Conclusions TG/HDL-C ratio may predict mortality risk among diabetic CAD patients receiving statin treatment. These findings suggest that assessing TG/HDL-C ratio may be useful for risk stratification for mortality risk in patients with diabetes and CAD.

Section: Discussionmentioning

confidence: 99%

Triglyceride to high-density lipoprotein cholesterol ratio predicts all-cause and cardiovascular mortality in diabetic patients with coronary artery disease on statin treatment

et al. 2021

Preprint

Background The triglyceride (TG)to high-density lipoprotein cholesterol (HDL-C) ratio has been regarded as an independent predictor of cardiovascular events. However, the association of TG/HDL-C ratio with survival in patients with diabetes and coronary artery disease (CAD) on statin therapy remains uncertain. The aim of the present study was to explore whether TG/HDL-C ratio predicts mortality in diabetic patients with CAD on statin treatment.Methods A total of 2080 consecutive patients with type 2 diabetes and angiographic-proven CAD who were treated with statin were enrolled in the presents study. Patients were divided into tertiles according to baseline TG/HDL-C ratio. The primary endpoints were all-cause and cardiovascular mortality.Results During 4-year follow-up, 209(10.0%) patients died, 136(65.1%) caused by cardiovascular disease (CVD). The Kaplan-Meier analyses showed that all-cause and cardiovascular mortality increased gradually with rising TG/HDL-C ratio tertiles (log-rank test, P < 0.001, respectively). Multivariate cox hazard regression analysis revealed that patients in tertile 3 but not teretile 2 had significantly higher rate of all-cause and cardiovascular mortality (P < 0.001, P < 0.05, respectively). Moreover, TG/HDL-C ratio was independently associated with all-cause mortality (HR: 1.21, 95% CI:1.11–1.31; P < 0.001) and cardiovascular mortality (HR:1.28, 95% CI: 1.19–1.37; P < 0.001). For all-cause mortality, TG/HDL-C ratio significantly improved the C-statistic (0.799[0.766–0.833] to 0.813[0.780–0.845]; P = 0.018), net reclassification index (NRI) (0.315; P < 0.001), and integrated discrimination index (IDI) (0.012; P = 0.003). For cardiovascular mortality, TG/HDL-C ratio significantly improved the C-statistic (0.769[0.727–0.812] to 0.810[0.771–0.849]; P = 0.001), NRI (0.442; P < 0.001), and IDI (0.039; P < 0.001).Conclusions TG/HDL-C ratio may predict mortality risk among diabetic CAD patients receiving statin treatment. These findings suggest that assessing TG/HDL-C ratio may be useful for risk stratification for mortality risk in patients with diabetes and CAD.