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

Abstract

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.