Abstract
Background: Early insulin resistance without diabetes can cause cardiovascular disease, which is a public health challenge. This study aimed to investigate the effects of the triglyceride to high-density lipid (HDL)-cholesterol ratio (TG/HDL-C), which could reflect insulin resistance from the beginning, on the incident risk of ischemic heart disease (IHD).Methods: We assessed 16,455 individuals (8,426 men and 8,029 women) without diabetes in a community-dwelling Korean cohort using National Health Insurance data. Participants were classified based on the TG/HDL-C quartiles. Using multivariate Cox proportional-hazards regression models, we prospectively examined the hazard ratios (HRs) with 95% confidence intervals (CIs) for IHD over 50 months after baseline enrolment.Results: During the follow-up period, 321 (2.0%) participants developed IHD. After adjusting for potential confounding variables, the HRs of IHD for TG/HDL-C quartiles were 1.00, 1.61 (95% CI, 1.05–2.48), 1.85 (95% CI, 1.21–2.81), and 2.29 (95% CI, 1.50–3.51), respectively. Compared with men, women showed higher HRs for the risk of incident IHD in the fourth quartile [HR (95% CI) = 2.98 [1.50–5.88] and 1.80 [1.02–3.17], respectively). Compared with metabolic syndrome, TG/HDL-C had a more powerful predictive value for IHD.Conclusions: In Koreans without diabetes, an increased TG/HDL-C precedes future IHD. Additionally, sex differences may merit serious consideration when interpreting TG/HDL-C for assessing cardiovascular risks in clinical practice.
Highlights
Ischemic heart disease (IHD) is a significant challenge among middle-aged individuals without diabetes
Epidemiological studies have reported the predictive utility of the TG to HDLC ratio (TG/high-density lipoprotein cholesterol (HDL-C)) for type 2 diabetes, which suggests that it is a simple and more accessible marker of insulin resistance from onset compared with homeostasis model assessment of insulin resistance or hyperinsulinemic-euglycemic clamp testing [7,8,9]
TG/high-density lipid (HDL)-C is closely associated with small dense low-density lipoprotein cholesterol (LDL-C) levels, which have atherogenic properties [10, 11]
Summary
Ischemic heart disease (IHD) is a significant challenge among middle-aged individuals without diabetes. Coronary heart disease can begin in early-stage insulin resistance [5], which may be overlooked in clinical settings. Management of IHD risk factors in the preclinical stage is important from a public health perspective, which facilitates disease prevention and delays IHD progression. Individuals with early insulin resistance often have increased and decreased triglyceride (TG) and high-density lipoprotein cholesterol (HDL-C) levels, respectively [6]. Insulin resistance without diabetes can cause cardiovascular disease, which is a public health challenge. This study aimed to investigate the effects of the triglyceride to high-density lipid (HDL)-cholesterol ratio (TG/HDL-C), which could reflect insulin resistance from the beginning, on the incident risk of ischemic heart disease (IHD)
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