Evaluation of triglyceride: HDL-C ratio and Non-HDL-C as harbingers of increased cardiovascular risk in metabolic syndrome

Dharuni R., Maruthi Prasad B. V., Vishwanath H. L., Harish R.


Background: Metabolic syndrome is an aggregate of conditions that together increases the risk of developing cardiovascular disease and type 2 diabetes mellitus. Dyslipidemia consisting of elevated triglyceride, decreased HDL, and altered triglyceride to high density lipoprotein- Cholesterol (TG/HDL-C) ratio is useful in predicting cardiometabolic risk and insulin resistance. The present study aimed to compile further evidence for clinical utility of TG/HDL-C ratio and Non HDL-C as simple, cost effective tools for early identification of cardiovascular disease risk in metabolic syndrome.

Methods: This study was carried out with hundred subjects. Fifty of these subjects were diagnosed with metabolic syndrome according to National Cholesterol Education Program Adult Treatment Panel III; while other fifty were age and gender matched healthy control subjects.

Results: The impact of cardiometabolic markers on metabolic syndrome was assessed separately in men and women by applying Mann Whitney ‘U’ test. Study showed highly significant increase in TG, HDL, TC/TG and TG/HDL-C ratio in women compared to men with p<0.01. The odds ratio of TG/HDL for women showed the highest ratio of 6, 95% CI (1.5225 to 23.6401) p=0.006 compared to men 4.9583, 95% CI (1.0088-24.3711), p=0.004.

Conclusions: This study demonstrated that TG/HDL-C ratio and Non HDL-C are strongly associated with metabolic syndrome in urban population. In comparison, TG/HDL-C is a better predictor of metabolic syndrome than non-HDL-C.


Metabolic syndrome, Triglyceride: HDL-C ratio, Non- high density lipoprotein cholesterol

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Papakonstantinou E, Lambadiari V, Dimitriadis G, Zampelas A. Metabolic syndrome and cardiometabolic risk factors. Curr Vasc Pharmacol. 2013;11:858-79.

Deepa M, Farooq S, Datta M, Deepa R, Mohan V. Prevalence of metabolic syndrome using WHO, ATPIII and IDF definitions in Asian Indians: the Chennai Urban Rural Epidemiology Study (CURES‐34). Diabetes/metabolism research and reviews. 2007;23:127-34.

Pandit K, Goswami S, Ghosh S, Mukhopadhyay P, Chowdury S. Metabolic syndrome in south Asians. Indian J Endocrinol Metab. 2012;16:44-55.

Kannel WB, Vasan RS, Keyes MJ, Sullivan LM, Robins SJ. Usefulness of the Triglyceride:High Density Lipoprotein versus the Cholesterol: High Density Lipoprotein Ratio for Predicting Insulin Resistance and Cardiometabolic Risk: from the Framingham Offspring Cohort. Am J Cardiol. 2008;101:497-501.

Di Bonito P, Moio N, Scilla C, Cavuto L, Sibilio G, Sanguigno E, et al. Usefulness of the high triglyceride-to-HDL cholesterol ratio to identify cardiometabolic risk factors and preclinical signs of organ damage in outpatient children. Diabetes Care. 2012;35:158-62.

Garg PR, Kabita S, Sinha E, Kalla L, Kaur L, Saraswathy KN. The association of non HDL cholesterol with the presence of metabolic syndrome in North Indian subjects with and without CAD. Ann Human Biol. 2013;40:111-15.

Bozbas H, Yildrr A, Karacaglar E, Demir O, Ulus T. Increased serum gamma-glutamyltransferase activity in patients with metabolic syndrome. Turk KardiyolDernArs. 2011;39(2):122-8.

Kasapoglu B, Turkay C, Bayram Y, Koca C. Role of GGT in diagnosis of metabolic syndrome: A clinic-based cross-sectional survey. Indian J Med Res. 2001;132: 56-61.

Avins AL, Neuhaus JM. Do triglycerides provide meaningful information about heart disease risk? Arch Int Med. 2000;160:1937-44.

Flowers E, Molina C, Mathur A, Reaven GM. Use of plasma triglyceride/high-density lipoprotein cholesterol ratio to identify increased cardio-metabolic risk in young, healthy South Asians. The Indian Journal of Medical Research. 2015;141(1):68-74.

Park YW, Zhu S, Palaniappan L, Heshka S, Carnethon MR, Heymsfield SB. The Metabolic Syndrome: Prevalence and Associated Risk Factor Findings in the US Population From the Third National Health and Nutrition Examination Survey, 1988-1994. Archives of internal medicine. 2003;163(4):427-36.

Carr MC. The emergence of the metabolic syndrome with menopause. J Clin Endocrinol Metab. 2003;88(6):2404-11.

Da Luz PL, Favarato D, Junior JRF-N, Lemos P, Chagas ACP. High Ratio of Triglycerides to HDL-Cholesterol Predicts Extensive Coronary Disease. Clinics (Sao Paulo, Brazil). 2008;63:427-32.

Shuo P, Yitong M. GW25-e2295 Best single predictor of metabolic syndrome via comparing the predicting ability of various anthropometric and atherogenic parameters among Uighur population in Xinjiang. J Am Coll Cardiol. 2014;64(16_S).

Li C, Ford ES, McBride PE, Kwiterovich PO, McCrindle BW, Gidding SS. Non–high-density lipoprotein cholesterol concentration is associated with the metabolic syndrome among US youth aged 12-19 years. The Journal of pediatrics. 2011;158:201-7.

Bos G, Dekker JM, Heine RJ. Non-HDL cholesterol contributes to the “hypertriglyceridemic waist” as a cardiovascular risk factor: The Hoorn study. Diabetes care. 2004; 27:283-4.

Di Bonito P, Valerio G, Grugni G, Licenziati MR, Maffeis C, Manco M, et al. Comparison of non-HDL-cholesterol versus triglycerides-to-HDL-cholesterol ratio in relation to cardiometabolic risk factors and preclinical organ damage in overweight/obese children: The CARITALY study, Nutrition, Metabolism and Cardiovascular Diseases. 2015;25:489-94.