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Zhang S, Cao C, Han Y, Hu H, Zheng X. A nonlinear relationship between the triglycerides to high-density lipoprotein cholesterol ratio and stroke risk: an analysis based on data from the China Health and Retirement Longitudinal Study. Diabetol Metab Syndr 2024; 16:96. [PMID: 38678294 PMCID: PMC11055270 DOI: 10.1186/s13098-024-01339-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 04/20/2024] [Indexed: 04/29/2024] Open
Abstract
OBJECTIVE The connection between triglycerides to high-density lipoprotein cholesterol (TG/HDL-C) ratio and stroke risk is controversial. Our goal was to explore this relationship in individuals aged 45 and older enrolled in the China Health and Retirement Longitudinal Study (CHARLS). METHODS Our analysis encompassed 10,164 participants from the CHARLS cohorts. We applied the Cox proportional-hazards regression model to evaluate the potential correlation between the TG/HDL-C ratio and stroke incidence. Using a cubic spline function and smooth curve fitting within the Cox model allowed us to unearth a possible non-linear pattern in this relationship. We also conducted thorough sensitivity and subgroup analyses to deepen our understanding of the TG/HDL-C ratio's impact on stroke risk. RESULTS Adjusting for various risk factors, we observed a significant link between the TG/HDL-C ratio and increased stroke risk in individuals aged 45 and above (HR: 1.03, 95% CI 1.00-1.05, P = 0.0426). The relationship appeared non-linear, with an inflection at a TG/HDL-C ratio of 1.85. Ratios below this threshold indicated a heightened stroke risk (HR: 1.28, 95% CI 1.06-1.54, P = 0.0089), while ratios above it did not show a significant risk increase (HR: 1.01, 95% CI 0.98-1.04, P = 0.6738). Sensitivity analysis confirmed the robustness of these findings. Notably, non-smokers exhibited a stronger correlation between the TG/HDL-C ratio and stroke risk compared to past and current smokers. CONCLUSION Our investigation revealed a significant, yet non-linear, association between the TG/HDL-C ratio and the incidence of stroke among individuals aged 45 and above. Specifically, we found that stroke risk increased in correlation with TG/HDL-C ratio below the threshold of 1.85. These insights may guide healthcare providers in advising and developing more effective strategies for stroke prevention in this demographic.
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Affiliation(s)
- Shike Zhang
- Department of Rehabilitation, Shenzhen Yantian District People's Hospital, Shenzhen, 518000, Guangdong, China
- Department of Rehabilitation, Southern University of Science and Technology Yantian Hospital, Shenzhen, 518000, Guangdong, China
| | - Changchun Cao
- Department of Rehabilitation, Shenzhen Second People's Hospital, Shenzhen Dapeng New District Nan'ao People's Hospital, Shenzhen, 518000, Guangdong, China
| | - Yong Han
- Department of Emergency, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, 518035, Guangdong, China
| | - Haofei Hu
- Department of Nephrology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, No. 3002, Sungang West Road, Futian District, Shenzhen, 518000, Guangdong, China.
| | - Xiaodan Zheng
- Department of Neurology, Shenzhen Samii Medical Center (The Fourth People's Hospital of Shenzhen), No. 1, Jinniu West Road, Shijing Street, Pingshan District, Shenzhen, 518000, Guangdong, China.
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Althwab SA, Abdulmonem WA, Allemailem KS, Alarifi SA, Hamad EM. Prediction of cardiovascular risk factors and metabolic syndrome in adults from Saudi Arabia using the logarithm of triglyceride/HDL-cholesterol ratio. Int J Health Sci (Qassim) 2024; 18:50-55. [PMID: 38455599 PMCID: PMC10915911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024] Open
Abstract
Objective Cardiovascular diseases (CVD) are the leading cause of death globally. Metabolic syndrome (MtS) is a risk factor that increases the likelihood of CVD. The atherogenic index (AIP), calculated as the logarithm of the ratio of triglycerides (TG) to high-density lipoprotein cholesterol (HDL) cholesterol in plasma, is a valuable marker for highly atherogenic small dense low-density lipoprotein cholesterol particles. This study aimed to explore MtS prevalence and investigate the potential of using the AIP as a predictor for CVD risk factors in adults from the Qassim region of Saudi Arabia. Methods The cross-sectional study enrolled 589 participants from public hospitals in nine major cities who completed a detailed questionnaire on health, diet, and lifestyle. Anthropometric measurements and some clinical parameters were measured. Results The findings indicated a significant prevalence of MtS (37.5%) among participants from the Qassim Area, which was higher in males (39.9%) than females (34.9%). Nevertheless, a significant prevalence was shown for CVD risk factors among participants, with hyperglycemia (78.1%), hypertriglyceridemia (39.0%), hypo-HDL-cholesterolemia (38.9%), and hypertension (21.6%) being common. The AIP's performance in identifying CVD risk factors showed a receiver operating characteristic value of 0.909 (P < 0.001). The optimal cutoff value for the AIP was determined to be 0.468, demonstrating high sensitivity (84.8%) and specificity (78.6%). Conclusion Incorporating AIP into clinical practice could enhance CVD risk prediction compared to using lipid profiles alone. These findings suggest that there is a high prevalence of MtS among adults in the Qassim region of Saudi Arabia. Further longitudinal studies are needed to recommend AIP as a robust tool for predicting CVD in clinical settings.
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Affiliation(s)
- Sami A. Althwab
- Department of Food Science and Human Nutrition, College of Agriculture and Veterinary Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Waleed Al Abdulmonem
- Department of Pathology, College of Medicine, Qassim University, Buraidah, Kingdom of Saudi Arabia
| | - Khaled S. Allemailem
- Department of Medical Laboratories, College of Applied Medical Sciences, Qassim University, Buraidah, Saudi Arabia
| | - Saud A. Alarifi
- Department of Zoology, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Essam M. Hamad
- Department of Food Science and Human Nutrition, College of Agriculture and Veterinary Medicine, Qassim University, Buraidah, Saudi Arabia
- Department of Dairy Science, Faculty of Agriculture, Cairo University, Giza, Egypt
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Mohseni P, Khalili D, Djalalinia S, Farzadfar F, Mehrabi Y. Identifying Factors Related to Serum Lipids Using Multilevel Quantile Model: Analysis of Nationwide STEPs Survey 2016. Int J Prev Med 2023; 14:69. [PMID: 37351060 PMCID: PMC10284246 DOI: 10.4103/ijpvm.ijpvm_464_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 10/27/2022] [Indexed: 06/24/2023] Open
Abstract
Background Lipid disorder is a modifiable risk factor for diseases related to plaque formation in arteries such as heart attack, stroke, and peripheral vascular diseases. Identifying related factors and diagnosis and treatment in time reduces the incidence of non-communicable diseases (NCDs). The aim of this study was to determine factors associated with lipids based on a national survey data. Methods Data of 16757 individuals aged 25-64 years obtained from the Iranian STEPwise approach to NCD risk factor surveillance (STEPs) performed in 2016, through multistage random sampling, were analyzed. Because of clustered, hierarchical, and skewed form of the data, factors related to total holesterol (TC), triglycerides (TG), low-density lipoprotein-cholesterol) (LDL-C), high-density lipoprotein-cholesterol) (HDL-C), TG/HDL-C, TC/HDL-C, and LDL-C/HDL-C were determined applying multilevel quantile mixed model. Parameters of the model were estimated on the basis of random effect of the province as well as urban or rural area for 10th, 25th, 50th, 75th, and 90th quantiles. Statistical analyses were performed by R software version 4.0.2. Results Significant relationship was found between age, body mass index (BMI), waist circumference (WC), diabetes, hypertension, smoking, physical activity, education level, and marital status with TC, LDL-C, HDL-C, LDL-C, and LDL-C/HDL-C. With increasing BMI and WC, subjects had higher levels of serum lipids, especially in higher quantiles of lipid levels. Lipid levels were significantly increased among smokers and those with diabetes or hypertension. The random effects were also significant showing that there is a correlation between the level of lipids in provincial habitants as well as urban and rural areas. Conclusions This study showed that the effect of each factor varies depending on the centiles of the lipids. Significant relationship was found between sociodemographic, behaviors, and anthropometric indices with lipid parameters.
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Affiliation(s)
- Parisa Mohseni
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Shirin Djalalinia
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Farshad Farzadfar
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Yadollah Mehrabi
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
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Basuliman AS, Malabarey MA, Abousamak FW, Alyousef BY, Alrabea SS, Alshabibi RA, Aseri ZAA. Predictive value of triglycerides to high density lipoprotein ratio in patients with first attack of acute coronary syndrome. Saudi Med J 2023; 44:379-384. [PMID: 37062558 PMCID: PMC10153615 DOI: 10.15537/smj.2023.44.4.20220928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 02/27/2023] [Indexed: 04/18/2023] Open
Abstract
OBJECTIVES To identify patients who are at risk for a first cardiovascular event, mitigate the risk, and institute early intervention. The triglyceride to high-density lipoprotein-C (TG/HDL-C) ratio has been found to be a very useful biomarker for directing treatment and prevention therapy. METHODS This retrospective cross-sectional study included adult patients (aged >18 years) experiencing first-time acute coronary syndrome (ACS). We examined all patient databases for a definite diagnosis of angina, non-ST segment elevation myocardial infarction (NSTEMI), or ST-segment elevation myocardial infarction (STEMI). Lipid profiles were obtained prior to or at the time of admission. RESULTS A total of 265 patients were included in the study (mean age 57.83 ± 11.4 years) and 79.2% were men. Male gender, presence of diabetes, raised total cholesterol, raised low-density lipoprotein (LDL), and raised troponin level on admission were significantly positively correlated with STEMI (p=0.004, p=0.001, p<0.001, and p<0.001), whereas TG/HDL-C ratio was significantly negatively correlated with STEMI (p=0.048), while there was no significant results with NSTEMI (p=0.264) and angina (p=0.326). Total cholesterol and raised low-density lipoprotein (LDL) were significantly positively correlated with NSTEMI (p=0.013 and p=0.024). CONCLUSION Patients with first-time ACS may not have an increased TG/HDL-C ratio. High LDL levels had the most significant association with an ACS event, along with total cholesterol and diabetes. Further research is needed on a larger scale to determine the association of TG/HDL-C ratio with ACS and differentiate the different types of ACS events according to their clinical and laboratory characteristics.
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Affiliation(s)
- Abdullah S. Basuliman
- From the College of Medicine (Basuliman, Alyousef, Alrabea), King Saud bin Abdulaziz University for Health Sciences; from the Departments of Emergency Medicine and Critical Care (Malabarey, Al Aseri), College of Medicine, King Saud University; from the Department of Clinical Sciences (Al Aseri), and from the College of Medicine (Abousamak, Alshabibi), Dar Al Uloom University; and from the Saudi Red Crescent Authority (Abousamak), Riyadh, Kingdom of Saudi Arabia.
| | - Mohammed A. Malabarey
- From the College of Medicine (Basuliman, Alyousef, Alrabea), King Saud bin Abdulaziz University for Health Sciences; from the Departments of Emergency Medicine and Critical Care (Malabarey, Al Aseri), College of Medicine, King Saud University; from the Department of Clinical Sciences (Al Aseri), and from the College of Medicine (Abousamak, Alshabibi), Dar Al Uloom University; and from the Saudi Red Crescent Authority (Abousamak), Riyadh, Kingdom of Saudi Arabia.
| | - Fahad W. Abousamak
- From the College of Medicine (Basuliman, Alyousef, Alrabea), King Saud bin Abdulaziz University for Health Sciences; from the Departments of Emergency Medicine and Critical Care (Malabarey, Al Aseri), College of Medicine, King Saud University; from the Department of Clinical Sciences (Al Aseri), and from the College of Medicine (Abousamak, Alshabibi), Dar Al Uloom University; and from the Saudi Red Crescent Authority (Abousamak), Riyadh, Kingdom of Saudi Arabia.
| | - Bader Y. Alyousef
- From the College of Medicine (Basuliman, Alyousef, Alrabea), King Saud bin Abdulaziz University for Health Sciences; from the Departments of Emergency Medicine and Critical Care (Malabarey, Al Aseri), College of Medicine, King Saud University; from the Department of Clinical Sciences (Al Aseri), and from the College of Medicine (Abousamak, Alshabibi), Dar Al Uloom University; and from the Saudi Red Crescent Authority (Abousamak), Riyadh, Kingdom of Saudi Arabia.
| | - Saleh S. Alrabea
- From the College of Medicine (Basuliman, Alyousef, Alrabea), King Saud bin Abdulaziz University for Health Sciences; from the Departments of Emergency Medicine and Critical Care (Malabarey, Al Aseri), College of Medicine, King Saud University; from the Department of Clinical Sciences (Al Aseri), and from the College of Medicine (Abousamak, Alshabibi), Dar Al Uloom University; and from the Saudi Red Crescent Authority (Abousamak), Riyadh, Kingdom of Saudi Arabia.
| | - Rakan A. Alshabibi
- From the College of Medicine (Basuliman, Alyousef, Alrabea), King Saud bin Abdulaziz University for Health Sciences; from the Departments of Emergency Medicine and Critical Care (Malabarey, Al Aseri), College of Medicine, King Saud University; from the Department of Clinical Sciences (Al Aseri), and from the College of Medicine (Abousamak, Alshabibi), Dar Al Uloom University; and from the Saudi Red Crescent Authority (Abousamak), Riyadh, Kingdom of Saudi Arabia.
| | - Zohair A. Al Aseri
- From the College of Medicine (Basuliman, Alyousef, Alrabea), King Saud bin Abdulaziz University for Health Sciences; from the Departments of Emergency Medicine and Critical Care (Malabarey, Al Aseri), College of Medicine, King Saud University; from the Department of Clinical Sciences (Al Aseri), and from the College of Medicine (Abousamak, Alshabibi), Dar Al Uloom University; and from the Saudi Red Crescent Authority (Abousamak), Riyadh, Kingdom of Saudi Arabia.
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Cummings PJ, Noakes TD, Nichols DM, Berchou KD, Kreher MD, Washburn PJ. Lifestyle Therapy Targeting Hyperinsulinemia Normalizes Hyperglycemia and Surrogate Markers of Insulin Resistance in a Large, Free-Living Population. AJPM FOCUS 2022; 1:100034. [PMID: 37791244 PMCID: PMC10546563 DOI: 10.1016/j.focus.2022.100034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Introduction This article reports the evaluation of a personalized, team-based comprehensive lifestyle modification program targeting known triggers of hyperinsulinemia and insulin resistance. Methods A retrospective chart review was undertaken for 536 participants in a novel high-intensity lifestyle behavioral modification program. Surrogate markers of insulin resistance and metabolic syndrome‒related pathologies were measured before and after participation in the the program. Results Reversal of metabolic syndrome was present in 42% of participants who met the criteria for this syndrome. Additional changes seen in this cohort include: 36% decrease in triglyceride to high-density lipoprotein cholesterol ratio; 5% (-7.2 mm Hg) decrease in systolic blood pressure and 4% (-3.8 mm Hg) decrease in diastolic blood pressure; decreased abdominal adiposity and waist circumference (-7.6 cm); increased high-density lipoprotein cholesterol (1.3 mg/dL); and 23% (-57.1 mg/dL) decrease in serum triglycerides. Hyperglycemia was normalized in 35% of participants with prediabetes. Only 2% of those with prediabetes progressed to type 2 diabetes mellitus. Among those with type 2 diabetes mellitus, 46% experienced a reduction in HbA1c to below diabetic cut offs. Compared to baseline, the Metabolic Syndrome Severity Score decreased by 30% among those with metabolic syndrome, 11% among those with prediabetes, 26% among those with type 2 diabetes mellitus, and 38% among those with uncontrolled type 2 diabetes mellitus. Cardiorespiratory fitness, measured by the calculated Metabolic Equivalent of Task maximum, increased by 30% in the metabolic syndrome cohort, 28% in the prediabetic cohort, 29% in the type 2 diabetes mellitus cohort, 29% in the uncontrolled type 2 diabetes mellitus cohort, and 32% in the cohort with obesity. Conclusion Modifying lifestyle factors that trigger hyperinsulinemia provided pleiotropic improvements to all measured surrogate markers of insulin resistance, mitigated the progressive nature of the insulin resistance and metabolic syndrome‒related chronic pathologies, reduced Metabolic Syndrome Severity Score, and improved cardiorespiratory fitness. These results suggest that earlier identification of the diagnostic criteria of metabolic syndrome and/or Metabolic Syndrome Severity Score and the prompt initiation of a comprehensive therapeutic lifestyle approach would significantly mitigate disease burden.
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Affiliation(s)
- Peter J. Cummings
- Department of Health and Rehabilitation, Restore Medical Fitness Center, Williamsville, New York
| | - Timothy D. Noakes
- Department of Applied Design, Cape Peninsula University of Technology, Bellville, South Africa
| | - David M. Nichols
- Department of Family Medicine, Lehigh Valley Health Network, Allentown, Pennsylvania
| | - Kathleen D. Berchou
- Department of Health and Rehabilitation, Restore Medical Fitness Center, Williamsville, New York
| | - Maria D. Kreher
- Department of Health and Rehabilitation, Restore Medical Fitness Center, Williamsville, New York
| | - Paul J. Washburn
- Department of Preventive and Lifestyle Medicine, Health Medical Institute, Cheyenne, Wyoming
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Huang YH, Wu YH, Tang HY, Chen ST, Wang CC, Ho WJ, Lin YH, Liu GH, Lin PY, Lo CJ, Yeh YM, Cheng ML. Gut Microbiota and Bile Acids Mediate the Clinical Benefits of YH1 in Male Patients with Type 2 Diabetes Mellitus: A Pilot Observational Study. Pharmaceutics 2022; 14:pharmaceutics14091857. [PMID: 36145605 PMCID: PMC9505101 DOI: 10.3390/pharmaceutics14091857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 11/16/2022] Open
Abstract
Our previous clinical trial showed that a novel concentrated herbal extract formula, YH1 (Rhizoma coptidis and Shen-Ling-Bai-Zhu-San), improved blood glucose and lipid control. This pilot observational study investigated whether YH1 affects microbiota, plasma, and fecal bile acid (BA) compositions in ten untreated male patients with type 2 diabetes (T2D), hyperlipidemia, and a body mass index ≥ 23 kg/m2. Stool and plasma samples were collected for microbiome, BA, and biochemical analyses before and after 4 weeks of YH1 therapy. As previous studies found, the glycated albumin, 2-h postprandial glucose, triglycerides, total cholesterol, and low-density lipoprotein cholesterol levels were significantly improved after YH1 treatment. Gut microbiota revealed an increased abundance of the short-chain fatty acid-producing bacteria Anaerostipes and Escherichia/Shigella. Furthermore, YH1 inhibited specific phylotypes of bile salt hydrolase-expressing bacteria, including Parabacteroides, Bifidobacterium, and Bacteroides caccae. Stool tauro-conjugated BA levels increased after YH1 treatment. Plasma total BAs and 7α-hydroxy-4-cholesten-3-one (C4), a BA synthesis indicator, were elevated. The reduced deconjugation of BAs and increased plasma conjugated BAs, especially tauro-conjugated BAs, led to a decreased glyco- to tauro-conjugated BA ratio and reduced unconjugated secondary BAs. These results suggest that YH1 ameliorates T2D and hyperlipidemia by modulating microbiota constituents that alter fecal and plasma BA compositions and promote liver cholesterol-to-BA conversion and glucose homeostasis.
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Affiliation(s)
- Yueh-Hsiang Huang
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taipei 105, Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan 333, Taiwan
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Yi-Hong Wu
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taipei 105, Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan 333, Taiwan
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Hsiang-Yu Tang
- Metabolomics Core Laboratory, Healthy Aging Research Center, Chang Gung University, Taoyuan 333, Taiwan
| | - Szu-Tah Chen
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan
| | - Chih-Ching Wang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan
| | - Wan-Jing Ho
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan
| | - Yi-Hsuan Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan
| | - Geng-Hao Liu
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan 333, Taiwan
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan
| | - Pei-Yeh Lin
- Department of Medical Nutrition Therapy, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Chi-Jen Lo
- Metabolomics Core Laboratory, Healthy Aging Research Center, Chang Gung University, Taoyuan 333, Taiwan
| | - Yuan-Ming Yeh
- Genomic Medicine Core Laboratory, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan
- Graduate Institute of Health Industry Technology, Chang Gung University of Science and Technology, Taoyuan 333, Taiwan
- Correspondence: (Y.-M.Y.); (M.-L.C.)
| | - Mei-Ling Cheng
- Metabolomics Core Laboratory, Healthy Aging Research Center, Chang Gung University, Taoyuan 333, Taiwan
- Clinical Metabolomics Core Laboratory, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
- Department of Biomedical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Correspondence: (Y.-M.Y.); (M.-L.C.)
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Park B, Jung DH, Lee HS, Lee YJ. Triglyceride to HDL-Cholesterol Ratio and the Incident Risk of Ischemic Heart Disease Among Koreans Without Diabetes: A Longitudinal Study Using National Health Insurance Data. Front Cardiovasc Med 2021; 8:716698. [PMID: 34490378 PMCID: PMC8418107 DOI: 10.3389/fcvm.2021.716698] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 07/27/2021] [Indexed: 12/24/2022] Open
Abstract
Background: Early insulin resistance without diabetes can cause cardiovascular disease, which is a public health challenge. This study aimed to investigate the effects of the triglyceride to high-density lipid (HDL)-cholesterol ratio (TG/HDL-C), which could reflect insulin resistance from the beginning, on the incident risk of ischemic heart disease (IHD). Methods: We assessed 16,455 individuals (8,426 men and 8,029 women) without diabetes in a community-dwelling Korean cohort using National Health Insurance data. Participants were classified based on the TG/HDL-C quartiles. Using multivariate Cox proportional-hazards regression models, we prospectively examined the hazard ratios (HRs) with 95% confidence intervals (CIs) for IHD over 50 months after baseline enrolment. Results: During the follow-up period, 321 (2.0%) participants developed IHD. After adjusting for potential confounding variables, the HRs of IHD for TG/HDL-C quartiles were 1.00, 1.61 (95% CI, 1.05–2.48), 1.85 (95% CI, 1.21–2.81), and 2.29 (95% CI, 1.50–3.51), respectively. Compared with men, women showed higher HRs for the risk of incident IHD in the fourth quartile [HR (95% CI) = 2.98 [1.50–5.88] and 1.80 [1.02–3.17], respectively). Compared with metabolic syndrome, TG/HDL-C had a more powerful predictive value for IHD. Conclusions: In Koreans without diabetes, an increased TG/HDL-C precedes future IHD. Additionally, sex differences may merit serious consideration when interpreting TG/HDL-C for assessing cardiovascular risks in clinical practice.
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Affiliation(s)
- Byoungjin Park
- Department of Family Medicine, Yongin Severance Hospital, Seoul, South Korea.,Department of Family Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Dong Hyuk Jung
- Department of Family Medicine, Yongin Severance Hospital, Seoul, South Korea.,Department of Family Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Department of Research Affairs, Yonsei University College of Medicine, Seoul, South Korea
| | - Yong Jae Lee
- Department of Family Medicine, Yonsei University College of Medicine, Seoul, South Korea.,Department of Family Medicine, Gangnam Severance Hospital, Seoul, South Korea
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Insulin Resistance Indexes as Biomarkers of Lifetime Cardiovascular Risk among Adults from Peru. J Nutr Metab 2021; 2021:6633700. [PMID: 33833874 PMCID: PMC8016568 DOI: 10.1155/2021/6633700] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 03/09/2021] [Accepted: 03/17/2021] [Indexed: 02/07/2023] Open
Abstract
Background Cardiovascular disease (CVD) is the most prevalent cause of death from disease and disability in the world. Reliable markers are needed to assess and reduce cardiovascular risk. This study aimed to determine if insulin resistance indexes, triglycerides to HDL-cholesterol ratio (TG/HDL-C), and triglyceride glucose index (TyG) are biomarkers for lifetime cardiovascular risk (CVR). Methods This analytical cross-sectional study was performed on health personnel from Huaycan Hospital in Peru. The QRISK model was used to measure lifetime CVR. The association and diagnostic accuracy for TyG calculated as Ln (TG (mg/dL) × glucose (mg/dL)/2) and TG/HDL-C ratio were determined using Poisson regression models and ROC curves with Youden index. Results In total, 291 adults (207 women and 84 men) were analyzed. In the adjusted Poisson models, each unit of TG/HDL-C increased 1.22-fold and 1.16-fold the probability of high lifetime CVR in men and women, respectively. However, each unit of TyG increased 1.98-fold in men and 3.25-fold in women the probability of high lifetime CVR. The optimal cutoff values of TG/HDL-C were 2.64 (AUC: 0.77), 3.90 (AUC: 0.80), and 2.64 (AUC: 0.74) for the overall population, men, and women, respectively. Likewise, the optimal cutoff values of TyG were 9.04 (AUC: 0.80), 8.95 (AUC: 0.79), and 9.04 (AUC: 0.80) for the overall population, men, and women, respectively. Conclusion TG/HDL-C and TyG presented a significant association with lifetime CVR. However, TyG presented a stronger association than TG/HDL-C. Both TG/HDL-C and TyG are shown to be reliable markers for CVR in adults.
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Zhang B, Dong C, Li S, Song X, Wei W, Liu L. Triglyceride to High-Density Lipoprotein Cholesterol Ratio is an Important Determinant of Cardiovascular Risk and Poor Prognosis in Coronavirus Disease-19: A Retrospective Case Series Study. Diabetes Metab Syndr Obes 2020; 13:3925-3936. [PMID: 33122929 PMCID: PMC7591232 DOI: 10.2147/dmso.s268992] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 08/26/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Acute myocardial injury and heart failure characterized by elevated cardiac troponin and decreased heart pump function are significant clinical features and prognostic factors of coronavirus disease-19 (COVID-19). Triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio is an indicator of insulin resistance. This study aimed to explore the association of the TG/HDL-C ratio with cardiovascular risk and prognosis in COVID-19. METHODS Ninety-eight laboratory-confirmed patients with COVID-19 admitted in a tertiary teaching hospital in Wuhan, China, were enrolled in this retrospective study. Regression models were used to investigate the association between TG/HDL-C ratio with myocardial injury, heart failure, severity, and mortality in COVID-19. RESULTS Among the 98 patients, the mean age was 63.9±1.4 years, and male sex (58, 59%) was predominant. Forty-six patients (47%) were admitted to the intensive care unit (ICU), 32 (33%) and 46 (47%) patients suffered from myocardial injury and heart failure, respectively, and 36 (37%) patients died. The TG/HDL-C ratio was increased in patients with myocardial injury, heart failure, severe illness, and fatal outcome (P<0.05 for each). Baseline TG/HDL-C ratio significantly correlated with log transformed levels of plasma high-sensitivity cardiac troponin I (r=0.251, P=0.018), N-terminal brain natriuretic propeptide (r=0.274, P=0.008), glycated hemoglobin (r=0.239, P=0.038), and interleukin-6 (r=0.218, P=0.042). Multivariate logistic regression analysis showed that an increased TG/HDL-C ratio was independently associated with the risk of myocardial injury [odds ratio (OR)=2.73; P=0.013], heart failure (OR=2.64; P=0.019), disease severity (OR=3.01; P=0.032), and fatal outcome (OR=2.97; P=0.014). CONCLUSION Increased TG/HDL-C ratio was independently associated with myocardial injury, heart failure, disease severity, and mortality in patients with COVID-19, and it may be a useful marker for early identification of patients with high risk and poor outcome.
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Affiliation(s)
- Benping Zhang
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei430030, People’s Republic of China
| | - Chen Dong
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei430030, People’s Republic of China
| | - Shengzhong Li
- Department of Surgery, Wuhan Jinyintan Hospital, Wuhan, Hubei430023, People’s Republic of China
| | - Xiaoqing Song
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei430030, People’s Republic of China
| | - Wang Wei
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei430030, People’s Republic of China
| | - Li Liu
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei430030, People’s Republic of China
- Correspondence: Li Liu Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Road, Wuhan, Hubei430030, People’s Republic of ChinaTel +86-027-83663470Fax +86-027-83662883 Email
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