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. 2024 Nov 13;24(1):639.
doi: 10.1186/s12872-024-04308-w.

The nonlineard association between triglyceride to HDL cholesterol ratio and long-term heart disease risk: findings from China Health and Retirement Longitudinal Study (CHARLS)

Ting-Yue Feng #  1 , Chi Chen #  1 , Gang Sun #  1 , Tao Zheng  2
Affiliations

The nonlineard association between triglyceride to HDL cholesterol ratio and long-term heart disease risk: findings from China Health and Retirement Longitudinal Study (CHARLS)

Ting-Yue Feng et al. BMC Cardiovasc Disord. .

Abstract

Objective: The aim of this study was to investigate the relationship between triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-C) and the risk of cardiovascular disease (CVD) in middle-aged and elderly Chinese population. CVD has high morbidity and mortality in China, with 5.09 million CVD deaths in 2019 and a mortality rate of 364.5 cases per 100,000 people. Existing studies have focused on specific populations and lack studies on the general population.

Methods: This study used data from the China Health and Aged Care Tracking Survey (CHARLS) to analyse the middle-aged and elderly population between 2011 and 2020. The exposure variable was TG/HDL-C ratio, the outcome variable was the occurrence of heart disease (including myocardial infarction, coronary heart disease, etc.), and the covariates included age, gender, education level, and body mass index. The final sample size was 4,551 participants. Weighted Cox regression models were used to assess the association between TG/HDL-C and CVD risk, and nonlinear associations and stratified analyses were performed.

Results: The results demonstrated a significant association between TG/HDL-C ratios and cardiac morbidity, with a risk ratio of 0.71 (95% CI: 0.71-0.71) in the adjusted model II. Nonlinear analysis revealed a threshold effect. Within the TG/HDL-C 0.15-1.5 interval (inflection point LnTG/HDL-C 0.41), each 1-unit increase in Ln (TG/HDL-C) was associated with a 17% reduction in the risk. The inflection point was associated with a 0.83-fold reduction in the risk of CVD (95% CI: 0.75, 0.92; p = 0.0003), but beyond this point, the association was no longer significant (1.00-fold reduction in risk; 95% CI: 0.95, 1.05; p = 0.9701). In contrast, stratified analyses demonstrated that the results were more applicable to women and those younger than 65 years.

Conclusion: In summary, the study found a significant inverse relationship between the triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio and the risk of cardiovascular disease in the middle-aged and elderly Chinese population, with a nonlinear threshold effect observed at a TG/HDL-C ratio of around 1.5.

Keywords: Cardiovascular disease (CVD); China Health and Retirement Longitudinal Study (CHARLS); Triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-C); U-shaped relationship.

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Conflict of interest statement

Declarations Ethics approval and consent to participate This study was approved by the Biomedical Ethics Committee of Peking University (IRB00001052-11015). The study adhered to the principles of Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). All participants were thoroughly informed and signed a written informed consent form prior to enrollment, thereby agreeing to participate in the baseline and follow-up surveys. Consent for publication Not applicable. Competing interests The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Figure 1 shows the flow chart of the study procedures, illustrating the process and rationale for selecting patients for final data analysis
Fig. 2
Fig. 2
Fig. 2: non-lienar relationship between Ln(TG/HDL-C) and the risk of cardiovascular disease (CVD)The solid line represents the estimated hazard ratios (HRs) for CVD incidence, and the dashed lines represent the 95% confidence intervals. The vertical red line indicates the inflection point at Ln(TG/HDL-C) = 0.41 (corresponding to TG/HDL-C ≈ 1.50). To the left of this point, increasing Ln(TG/HDL-C) is associated with decreasing CVD risk (HR < 1). To the right of this point, increasing Ln(TG/HDL-C) is associated with increasing CVD risk (HR > 1). The nonlinear illustrates that both very low TG/HDL-C ratios are associated with increased CVD risk
See this image and copyright information in PMC

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