Simple cut-point for elevated TG/HDL-C ratio identifies high risk patients

A TG/HDL-C ratio of ≥2.5 is an independent predictor of long-term all-cause mortality and strongly associated with an increased risk of major adverse cardiac events (MACE).

A Victorian study published in Heart, Lung and Circulation, comprising 482 patients who underwent coronary angiography and were followed for five years, found the TG/HDL-C ratio cut-point of 2.5 was relevant for both men and women.

The cohort was mostly men (69%) with hypertension and high cholesterol. Almost 30% had diabetes and about a third (32.9%) had a history of AMI.

The majority of patients (70.8%) had coronary artery disease that was either diagnosed at angiography or they had previous PCI for stenosis. Most were already taking cardiac medications including statins, aspirin, beta-blockers or ACE inhibitors.

Baseline TG/HDL-C ratios ranged from 0.21 to 7.73.

The study found a significant two-fold increase in all-cause mortality between patients with a baseline TG/HDL-C ratio of <2.5 and those with a TG/HDL-C ratio ≥2.5 (9.1% v 18.2%; RR 2.10).

“All-cause mortality remained significantly elevated when diabetics and obese patients were excluded from the analysis in the multivariate Cox-regression model (HR 2.07, p = 0.04), suggesting that TG-HDL-C ratio ≥2.5 is an independent predictor of all-cause mortality,” the study said.

Patients with TG/HDL-C ratio ≥2.5 were also at a significantly higher risk of MACE (HR 2.07, p=0.001) cardiac death (HR 2.24, p=0.04) and non-fatal AMI (HR 6.22, p<0.001) compared to patients with TG/HDL-C ratio <2.5.

“This indicates that a TG/HDL-C ratio ≥2.5 may offer a simpler approach compared to using tertiles or quartiles of TG/HDL-C levels to identify high-risk individuals with adverse cardiometabolic risk profiles,” the study said.

First author on the study Dr Rohullah Sultani, currently a medical registrar at Ballarat Base Hospital, told the limbic the cut point would help identify which patients may require more regular follow-up and more aggressive treatment.

“If non-pharmacological strategies have been implemented and despite that the ratio is still on the high side then alternative ways should be considered which include optimising their current statin medication or adding on a second agent to better manage their lipid profile.”

“So if they are on a low dose statin, escalate it from 40 to 80mg. Or if their TG/HDL-C ratio remains more than 2.5, maybe consider adding another agent.”


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