Methods: Survival analysis was done in 39,447 men grouped by TG/HDL-C ratio cut point of 3.5 and for metabolic syndrome. National Death Index International Classification of Diseases (ICD-9 and ICD-10) codes were used for CVD and CHD deaths occurring from 1970 to 2008.
This study shows that a high TG/HDL-C ratio in men is a
predictor of mortality from CHD and CVD. The TG/HDL-C ratio
had a significant and higher HR for mortality from CHD and
CVD than was found for the TyG index (TG x Glucose). These 2 measures, TG/HDL-C ratio and TyG index, similarly predicted incidence of type
2 diabetes, but the HR associated with a high TG/HDL-C seems
to make the ratio a preferred single parameter of measurement. In
this study, we also noted that the HRs for prediction of CHD,
CVD, and all-cause mortality were similar for the TG/HDL-C
ratio and the metabolic syndrome except when the latter was
adjusted for non-HDL-C and other factors (Table 2).
Kannel et al. questioned whether this ratio is better than the total cholesterol/HDL-C ratio for defining risk for CHD. For the Framingham Heart Study population, these workers found that the TG/HDL-C correlated with insulin resistance (estimated by homeostasis model assessment–insulin resistance) only moderately. Furthermore, these ratios had power to predict CHD only slightly better than did the total cholesterol/HDL-C ratio. (My comment: slightly better means at least as good as TC/HDL ratio which is commonly presented in routine lab reports. However TG/HDL is rarely if ever printed on any lab report that I have ever seen!)
45% of persons with a high TG/HDL ratio did not have metabolic syndrome. Therefore, it independently points to greater risk for CVD. At the same time, the finding of a high ratio calls for more attention to individual metabolic risk factors such as abdominal obesity, hypertension, and dysglycemia.
These 45% with high TG/HDL ratio don’t qualify for Met syn because it needs 3 criteria out of 5. Nevertheless, this study shows if ratio is >3.5 they are at higher risk than those <3.5 for mortality from CHD, CVD as well as all- cause! If a doc uses Met Syn criteria to screen for high risk persons, he will miss 45% of those with high risk of dying from all causes (ie. If he ignores those who have only high TG & low HDL). Docs who are brain-washed by statin producers focus on LDL-C only & ignores the importance of TG & HDL which is highlighted by this study with huge sample size & statistical power.