Triglyceride/High-Density Lipoprotein Cholesterol Concentration Ratio Identifies Accentuated Cardio-Metabolic Risk

PURPOSE: Plasma triglyceride/high-density lipoprotein cholesterol ratios (TG/HDL-C) have been shown to identify apparently healthy individuals at increased cardio-metabolic risk. This study evaluates the utility of this approach in patients at risk of developing diabetes. METHODS: Individuals (n=1010) in a private practice identified at increased risk of type 2 diabetes (T2DM) by American Association of Clinical Endocrinologist criteria, were evaluated. Subjects had measurements of body mass index (BMI), blood pressure (BP), lipid/lipoprotein concentrations, highly sensitive C-reactive protein (hs-CRP), and glucose, insulin and c-peptide concentrations during a 75gm, glucose challenge. The TG/HDL-C ratio was used to stratify individuals into high (highest quartile) vs. low (lowest 3 quartiles) risk categories. RESULTS: TG/HDL-C ratios identifying the highest quartile differed in men (\textgreater/= 3.0) and women (\textgreater/= 2.0). Using these cut-points, the high risk group for men and women had significantly higher BP, a more adverse lipid profile, was more insulin resistant as assessed by HOMA-IR, or the Matsuda index and had higher hs-CRP concentrations for men and women. Combined, approximately 25% of highest quartile patients expressed values \textgreater/= 3.0 mg/dL. CONCLUSION: The TG/HDL-C ratio provides a simple approach to identify individuals at accentuated cardio-metabolic risk within a population of perceived increased risk of T2DM. This was particularly the case as regards the presence of insulin resistance. Given the many syndromes associated with insulin resistance, including T2DM and coronary heart disease, an elevated TG/HDL-C ratio supports more aggressive efforts to enhance insulin sensitivity.