Relation Among the Plasma Triglyceride/High-Density Lipoprotein Cholesterol Concentration Ratio, Insulin Resistance, and Associated Cardio-Metabolic Risk Factors in Men and Women

doi:10.1016/j.amjcard.2012.02.016

The American Journal of Cardiology

Volume 109, Issue 12, 15 June 2012, Pages 1749-1753

https://doi.org/10.1016/j.amjcard.2012.02.016 Get rights and content

Results of recent studies using the ratio of plasma triglyceride (TG) to high-density lipoprotein (HDL) cholesterol concentration to identify insulin-resistant patients at increased cardiometabolic risk have emphasized that the cut point used for this purpose will vary with race. Because TG and HDL cholesterol concentrations vary with gender, this analysis was initiated to define gender-specific plasma TG/HDL cholesterol concentration ratios that best identified high-risk subjects among women (n = 1,102) and men (n = 464) of primarily European ancestry. Insulin resistance was defined as the 25% of the population with the highest values for fasting plasma insulin concentration and homeostasis model assessment of insulin resistance. Using TG/HDL concentration ratios >2.5 in women and >3.5 in men identified subgroups of men and women that were comparable in terms of insulin resistance and associated cardiometabolic risk, with significantly higher values for fasting plasma insulin, homeostasis model assessment of insulin resistance, blood pressure, body mass index, waist circumference, and glucose and TG concentrations and lower HDL cholesterol concentrations than in women and men below these cut points. The sensitivity and specificity of these gender-specific cut points to identify insulin-resistant subjects were about 40% and about 80%, respectively. In conclusion, the plasma TG/HDL cholesterol concentration ratio that identifies patients who are insulin resistant and at significantly greater cardiometabolic risk varies between men and women.

Section snippets

Methods

As part of community intervention programs on cardiovascular risk factors, epidemiologic studies on hypertension, renal disease, and other cardiometabolic risk factors were conducted in Rauch, in the province of Buenos Aires, Argentina (the RAUCH project), and San Andrés de Giles, also in the province of Buenos Aires (the PROCER project). According to the last national census available, there were 8,246 and 13,922 inhabitants aged ≥15 years in the urban areas of Rauch and San Andrés de Giles,

Results

Table 1 lists the demographic and metabolic characteristics of the experimental population, divided on the basis of study site and gender. In general, the values in the 2 populations were comparable, although the Rauch group was somewhat older, with higher blood pressures. Given the relative comparability of the values at the 2 sites, the experimental data are combined in the tables. It should be noted that the men and women were not different in terms of age, FPI, HOMA-IR, and body mass index,

Discussion

The possibility that the plasma TG/HDL cholesterol concentration ratio might be helpful in identifying subjects without known disease, likely to be insulin resistant, with the associated metabolic abnormalities that increase risk for coronary heart disease (CHD), seemed worth exploring for at least 5 reasons. First, increases in plasma TG and decreases in HDL cholesterol concentration have been identified as risk factors for CHD.17, 18 Second, the TG/HDL cholesterol ratio, often elevated in

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Triglyceride/HDL cholesterol ratio and lipoprotein insulin resistance Score: Associations with subclinical atherosclerosis and incident cardiovascular disease
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The triglyceride/HDL cholesterol (TG/HDL-C) ratio and the Lipoprotein Insulin Resistance (LP-IR) score are lipid markers of insulin resistance. Their associations with carotid intima media thickness (cIMT; subclinical atherosclerosis) and incident cardiovascular disease (CVD) have not been thoroughly investigated.
In a cross-sectional cohort (89 subjects without type 2 diabetes (T2D) and 81 subjects with T2D we determined cIMT (ultrasound), homeostasis model assessment of insulin resistance (HOMA-IR) and the TG/HDL-C ratio. The LP-IR score, based on 6 lipoprotein characteristics determined by nuclear magnetic resonance spectroscopy, was measured in 123 participants. A prospective study was carried out among 6232 participants (Prevention of REnal and Vascular ENd-stage Disease study).
Cross-sectionally, the adjusted associations of HOMA-IR, the TG/HDL-C ratio and the LP-IR score with cIMT were approximately similar (standardized β = 0.34 (95 % CI 0.19–0.48), 0.24 (95 % CI 0.09–039) and 0.41 (95 % CI 0.23––0.59), respectively). Prospectively, 507 new cases of CVD were observed after a median follow-up of 8.2 (interquartile range 7.5–8.8) years. HOMA-IR, the TG/HDL-C ratio and LP-IR were each associated with incident CVD independent of potential confounders (HR 1.12, 95 % CI 1.02–1.24;1.22, 95 % CI 1.11–1.35 and 1.15. 95 % CI 1.01–1.31, respectively). The association of the TG/HDL-C ratio with incident CVD was somewhat stronger than that of HOMA-IR.
Lipoprotein-based markers of insulin resistance are at least as strongly associated with subclinical atherosclerosis and clinical atherosclerosis development as HOMA-IR, obviating the need to measure insulin to determine the impact of insulin resistance. For practical purposes, the easily obtainable TG/HDL-C ratio may suffice.
Comparison of low-density lipoprotein cholesterol estimation methods in individuals with insulin resistance: A cross-sectional study
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The Friedewald, Sampson, and Martin equations were developed to estimate low-density lipoprotein cholesterol levels; however, the validation data of these equations with and without insulin resistance are insufficient.
We collected data on low-density lipoprotein cholesterol and lipid profiles from the Korea National Health and Nutrition Examination Survey. Using the data on insulin requirement, insulin resistance was calculated for 4,351 participants (median age, 48 [36–59] years; 49.9% male) using the homeostatic model assessment for insulin resistance (n = 2,713) and quantitative insulin-sensitivity check index (n = 2,400).
According to the mean and median absolute deviation, the Martin equation yielded more accurate estimates than other equations when the triglyceride level was < 400 mg/dL with insulin resistance; the Sampson equation yielded lower estimates when the direct low-density lipoprotein cholesterol level was < 70 mg/dL and triglyceride level was < 400 mg/dL without insulin resistance. However, the three equations yielded similar estimates when the triglyceride level was < 150 mg/dL with and without insulin resistance.
The Martin equation yielded more appropriate estimates than the Friedewald and Sampson equations for triglyceride levels < 400 mg/dL with and without insulin resistance. If the triglyceride level was < 150 mg, the Friedewald equation could also be considered.
Saturated fat from dairy sources is associated with lower cardiometabolic risk in the Framingham Offspring Study
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Current dietary guidance recommends limiting intakes of saturated fats, but most fails to consider that saturated fats from different food sources may have different health effects.
We aimed to evaluate the associations of saturated fats from dairy and nondairy sources with measures of body fat, inflammatory biomarkers, lipid concentrations, and lipid particle sizes and concentrations.
The Framingham Offspring Study is a prospective cohort study. Participants (n = 2391) ≥30 y of age who had dietary records and data on the outcomes of interest were included.
Among females, those in the highest quintile (compared with the lowest) of dairy-derived saturated fat had lower multivariable-adjusted levels of body fat [BMI (in kg/m²): 26.2 compared with 27.8, P < 0.01; and percentage fat mass: 36.7% compared with 38.0%, P = 0.09) and larger LDL particle sizes. Nondairy saturated fat in females was inversely associated with the triglyceride (TG):HDL ratio (P = 0.03). Among males, intakes of dairy-derived saturated fats were inversely associated with C-reactive protein (P < 0.01), fibrinogen (P < 0.01), TGs (P < 0.01), and the TG:HDL ratio (P < 0.01). HDL cholesterol was 2.8 mg/dL (P = 0.04) higher among males in the highest (compared with the lowest) quintile of saturated fat from dairy sources. Males with the highest intakes of dairy-derived saturated fats had larger HDL and LDL particle sizes (P < 0.01 for both), a higher HDL particle concentration (P < 0.01), and a lower VLDL particle concentration (P < 0.01). There were no statistically significant adverse effects of saturated fats from nondairy sources on any of these outcomes in either males or females.
Males with higher intakes of dairy-derived saturated fats had a less atherogenic profile than males with lower intakes of these fats. These effects were weaker in females. Nondairy saturated fats were not associated with these cardiometabolic outcomes.
Simultaneous evaluation of fatty acid and triglycerides after percutaneous coronary intervention
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Clinical studies have shown that the ratio of eicosapentaenoic acid to arachidonic acid (EPA/AA ratio) as well as the triglyceride (TG) levels can be considered as independent risk factors for cardiovascular diseases. The aim of this study was to investigate whether simultaneous evaluation of the EPA/AA ratio and TG level can affect the incidence of cardiovascular events after percutaneous coronary intervention (PCI).
We retrospectively examined the clinical records of 1585 patients who underwent successful PCI for acute coronary syndrome or stable angina. They were divided into four categories based on an EPA/AA ratio of 0.4 and a TG level of 150 mg/dl (a method termed the “Fatty Acid Window”). Among the four categories, the incidence of major adverse cardiac events (MACE) was measured for a maximum of five years after PCI. MACE was defined as cardiac death, non-fatal myocardial infarction, or revascularization due to new coronary stenosis or restenosis. The Kaplan-Meier method and the Cox proportional hazards regression analysis demonstrated that patients with both lower EPA/AA ratios and higher TG levels had a significantly higher incidence of MACE. In addition, patients with either lower EPA/AA ratios or higher TG levels also had a higher incidence of MACE compared to patients with both higher EPA/AA ratios and lower TG levels.
Evaluating both EPA/AA ratios and TG levels, a method termed the “Fatty Acid Window”, can be useful in predicting the occurrence of cardiovascular events after PCI.
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Citation Excerpt :
Therefore, we believe that beneficial changes in the lipid profile of active individuals took place mainly due to the practice of physical activity, causing active elderly people to obtain better rates even when compared to sedentary middle-aged men. However, several studies suggest that analyzing the relationship of biochemical risk factors with HDL, a protective molecule, would be a better risk predictor for several cardiovascular diseases and metabolic syndrome (Salazar et al., 2012). With this, many studies seek to evaluate and the relationship between different biochemical markers in order to identify which are the best markers for different types of diseases (Ain et al., 2019; Hegazy et al., 2020).
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Preventive cardiologyRelation Among the Plasma Triglyceride/High-Density Lipoprotein Cholesterol Concentration Ratio, Insulin Resistance, and Associated Cardio-Metabolic Risk Factors in Men and Women

Section snippets

Methods

Results

Discussion

Am J Cardiol

Metabolism

Metabolism

Lancet

Evidence for an independent relationship between insulin resistance and fasting plasma HDL-cholesterol, triglyceride and insulin concentrations

J Int Med

Use of metabolic markers to identify overweight individuals who are insulin resistant

Ann Intern Med

Wanted ! A standardized measurement of plasma insulin concentration

Arterioscler Thromb Vasc Biol

Fasting triglyceride and the triglyceride-HDL cholesterol ratio are not markers of insulin resistance in African Americans

Arch Intern Med

The prediction of insulin resistance with serum triglyceride and high-density lipoprotein cholesterol levels in an East African population

Arch Intern Med

The triglyceride/high-density lipoprotein cholesterol ratio fails to predict insulin resistance in African-American women: an analysis of Jackson Heart Study

Metab Syndr Relat Disord

Does the association of the triglyceride to high-density lipoprotein cholesterol ratio with fasting serum insulin differ by race/ethnicity?

Cardiovasc Diabetol

Taking sex into account in medicine

Lancet

Sex difference in the kinetics of triglyceride metabolism in normal and hypertriglyceridaemic human subjects

Eur J Clin Invest

Preventive cardiology
Relation Among the Plasma Triglyceride/High-Density Lipoprotein Cholesterol Concentration Ratio, Insulin Resistance, and Associated Cardio-Metabolic Risk Factors in Men and Women