TRIGLYCERIDE/HIGH-DENSITY LIPOPROTEIN CHOLESTEROL CONCENTRATION RATIO IDENTIFIES ACCENTUATED CARDIOMETABOLIC RISK

Abstract

OBJECTIVE: Plasma triglyceride (TG)/high-density lipoprotein cholesterol (HDL-C) ratios have been shown to identify apparently healthy individuals at increased cardiometabolic risk. This study evaluated the utility of this approach in patients at risk of developing diabetes. METHODS: Individuals (n = 1,010) treated at a private practice identified as being at an increased risk of type 2 diabetes mellitus (T2DM) based on American Association of Clinical Endocrinologist criteria were evaluated. Subjects had measurements of body mass index (BMI); blood pressure; lipid/lipoprotein concentrations; high-sensitivity C-reactive protein (hs-CRP) levels and glucose, insulin, and C-peptide concentrations during a 75-g, glucose challenge. The TG/HDL-C ratio was used to stratify individuals into high (highest quartile) and low (lowest 3 quartiles) risk categories. RESULTS: The TG/HDL-C ratios identifying the highest quartile differed in males (≥3.0 mg/dL) and females (≥2.0 mg/dL). Using these cutpoints, the. high-risk groups for males and females had significantly higher blood pressure, more adverse lipid profiles, were more insulin resistant as assessed by the homeostatic model assessment-insulin resistance (HOMA-IR) or the Matsuda index, and had higher hs-CRP concentrations. Combined, approximately 25% of highest quartile patients expressed values ≥3.0 mg/dL. CONCLUSION: The TG/HDL-C ratio provides a simple approach to identify individuals at higher cardiometabolic risk within a population of perceived increased risk of T2DM. This was especially true for insulin resistance. Given the many syndromes associated with insulin resistance, including T2DM and coronary heart disease, an elevated TG/HDL-C ratio supports more aggressive efforts to enhance insulin sensitivity.