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. 2021 Oct 20;11(1):20714.
doi: 10.1038/s41598-021-00020-3.

Triglycerides and low HDL cholesterol predict coronary heart disease risk in patients with stable angina

Chiara Caselli  1   2 , Raffaele De Caterina  3 , Jeff M Smit  4 , Jonica Campolo  5 , Mohammed El Mahdiui  4 , Rosetta Ragusa  6   7 , Alberto Clemente  8 , Tiziana Sampietro  8 , Aldo Clerico  8   7 , Riccardo Liga  3 , Gualtiero Pelosi  6 , Silvia Rocchiccioli  6 , Oberdan Parodi  6   8 , Arthur Scholte  4 , Jhuani Knuuti  9 , Danilo Neglia  10   11 ; EVINCI and SMARTool
Affiliations

Triglycerides and low HDL cholesterol predict coronary heart disease risk in patients with stable angina

Chiara Caselli et al. Sci Rep. .

Abstract

We assessed whether high triglycerides (TG) and low high-density lipoprotein cholesterol (HDL-C) levels, expressed by an increased TG/HDL-C ratio, predict coronary atherosclerotic disease (CAD) outcomes in patients with stable angina. We studied 355 patients (60 ± 9 years, 211 males) with stable angina who underwent coronary computed tomography angiography (CTA), were managed clinically and followed for 4.5 ± 0.9 years. The primary composite outcome was all-cause mortality and non-fatal myocardial infarction. At baseline, the proportion of males, patients with metabolic syndrome, diabetes and obstructive CAD increased across TG/HDL-C ratio quartiles, together with markers of insulin resistance, hepatic and adipose tissue dysfunction and myocardial damage, with no difference in total cholesterol or LDL-C. At follow-up, the global CTA risk score (HR 1.06, 95% confidence interval (CI) 1.03-1.09, P = 0.001) and the IV quartile of the TG/HDL-C ratio (HR 2.85, 95% CI 1.30-6.26, P < 0.01) were the only independent predictors of the primary outcome. The TG/HDL-C ratio and the CTA risk score progressed over time despite increased use of lipid-lowering drugs and reduction in LDL-C. In patients with stable angina, high TG and low HDL-C levels are associated with CAD related outcomes independently of LDL-C and treatments.Trial registration. EVINCI study: ClinicalTrials.gov NCT00979199, registered September 17, 2009; SMARTool study: ClinicalTrials.gov NCT04448691, registered June 26, 2020.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
TG/HDL-C ratio and cardio-metabolic risk. Relationship between baseline TG/HDL-C ratio, specific cardiovascular risk factors (Panel A), and relevant bio-humoral variables (Panel B, C, D).
Figure 2
Figure 2
Survival analysis. Unadjusted Kaplan–Meier estimates of the primary composite endpoint according to TG/HDL-C quartiles (IV vs I-II-III) in the whole population (Panel A) or after exclusion of diabetic patients (Panel B).
Figure 3
Figure 3
Association of TG/HDL-C ratio with progression of cardio-metabolic and CAD risk. Bar graphs represent ∆ changes (follow-up minus baseline) for the TGs (A), remnant-C (B), TG/HDL-C ratio (C), TyG index (D), CTA score (E), and IL-6 (F) levels from baseline to follow-up in two groups defined by baseline TG/HDL-C ratio below (low) or above (high) the median value.
Figure 4
Figure 4
Study flow diagram.
See this image and copyright information in PMC

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