Triglyceride to High-Density Lipoprotein Ratio can predict coronary artery calcification

Objectives: We assessed the TG/HDL-C ratio as a predictor for the presence of coronary artery calcifications (CACs). Methods: We collected demographic characteristics (age and gender), physical examination (height, weight, BMI, SBP, DBP), comorbidities, medication use, and laboratory variables Triglyceride to High-Density Lipoprotein (TG, HDL-C, TG/HDL-C, UA, TBG, 25-OH-VitD3); and we used coronary angiography to determine the presence of CACs. We performed univariate and multivariate analyses to evaluate the correlation between the TG/HDL-C ratio and CACs and established a predictive model. Results: CAC was present in 121 patients (25.80%). The levels of TG and TG/HDL-C ratio in the CAC group were higher than those in the non-CAC group, while the level of HDL-C in the CAC group was lower than that in the non-CAC group. The univariate analysis showed that the TG/HDL-C ratio was associated with CAC (OR, 0.021; 95% CI, 0.008 to 0.052; P<0.001), and the multivariate analysis indicated that the ratio was an independent risk factor for CAC (OR, 4.088; 95% CI, 2.787-5.996; P<0.001). Using the ratio to establish a prediction model, the area under the ROC curve was 0.814 (95% CI, 0.775-0.853; P<0.001), suggesting that the TG/HDL-C ratio has a high diagnostic efficiency. The diagnostic threshold was 1.037, and the corresponding sensitivity and specificity were 89.3% and 60.5%, respectively. Conclusion: The Triglyceride to High-Density Lipoprotein TG/HDL-C ratio is an independent risk factor for CAC with good diagnostic efficacy. Abbreviations: TG: Triglycerides, HDL-C: High-Density Lipoprotein, CAC: Coronary Artery Calcifications, BMI: Body Mass Index, SBP: Systolic Blood Pressure, DBP: Diastolic Blood Pressure, UA: Uric Acid, FBG: Fasting Blood Glucose, 25-OH-VitD3: 25-Hydroxyvitamin D3, ACEI: Angiotensin-Converting Enzyme Inhibitors, ARB: Angiotensin Receptor Blockers, CCB: Calcium Channel Blockers, ARNI: Angiotensin Receptor-Neprilysin Inhibitor, CAG: Coronary Angiography, AUCROC: Area Under the Receiver Operating Curve. doi: https://doi.org/10.12669/pjms.38.3.5290 How to cite this:Wang B, Hua J, Ma L. Triglyceride to High-Density Lipoprotein Ratio can predict coronary artery calcification. Pak J Med Sci. 2022;38(3):---------. doi: https://doi.org/10.12669/pjms.38.3.5290 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Assessing the Accuracy of Estimated Lipoprotein(a) Cholesterol and Lipoprotein(a)‐Free Low‐Density Lipoprotein Cholesterol

Background Accurate measurement of the cholesterol within lipoprotein(a) (Lp[a]‐C) and its contribution to low‐density lipoprotein cholesterol (LDL‐C) has important implications for risk assessment, diagnosis, and treatment of atherosclerotic cardiovascular disease, as well as in familial hypercholesterolemia. A method for estimating Lp(a)‐C from particle number using fixed conversion factors has been proposed (Lp[a]‐C from particle number divided by 2.4 for Lp(a) mass, multiplied by 30% for Lp[a]‐C). The accuracy of this method, which theoretically can isolate “Lp(a)‐free LDL‐C,” has not been validated. Methods and Results In 177 875 patients from the VLDbL (Very Large Database of Lipids), we compared estimated Lp(a)‐C and Lp(a)‐free LDL‐C with measured values and quantified absolute and percent error. We compared findings with an analogous data set from the Mayo Clinic Laboratory. Error in estimated Lp(a)‐C and Lp(a)‐free LDL‐C increased with higher Lp(a)‐C values. Median error for estimated Lp(a)‐C <10 mg/dL was −1.9 mg/dL (interquartile range, −4.0 to 0.2); this error increased linearly, overestimating by +30.8 mg/dL (interquartile range, 26.1–36.5) for estimated Lp(a)‐C ≥50 mg/dL. This error relationship persisted after stratification by overall high‐density lipoprotein cholesterol and high‐density lipoprotein cholesterol subtypes. Similar findings were observed in the Mayo cohort. Absolute error for Lp(a)‐free LDL‐C was +2.4 (interquartile range, −0.6 to 5.3) for Lp(a)‐C<10 mg/dL and −31.8 (interquartile range, −37.8 to −26.5) mg/dL for Lp(a)‐C≥50 mg/dL. Conclusions Lp(a)‐C estimations using fixed conversion factors overestimated Lp(a)‐C and subsequently underestimated Lp(a)‐free LDL‐C, especially at clinically relevant Lp(a) values. Application of inaccurate Lp(a)‐C estimations to correct LDL‐C may lead to undertreatment of high‐risk patients.

The Ratio of Free Fatty Acids (Ffas) Divided By High-Density Lipoprotein Cholesterol (HDL-C) Is A Promising Pre-Treatment Biomarker For Predicting Worse Overall Survival (OS) of Neuroendocrine Tumours (Nets) In The Colorectum: A Retrospective Study.

Background: free fatty acids (FFAs) and high-density lipoprotein cholesterol (HDL-C) were associated with various malignancy. However, whether FFA, HDL-C and FFA/HDL-C can play a potiential role in predicting patients with colorectal neuroendocrine tumours (NETs) was unclear. Meanwhile, FFA/HDL-C has a superior prognosis ability was unknown, too.Methods: One hundred patients with pathologically diagnosed colorectal NETs in 2011-2017 were enrolled, and the levels of FFA, HDL-C, low-density lipoprotein cholesterol (LDL-C), triglycerides (TGs), cholesterol (CHOL), apolipoprotein A1 (ApoA1) and apolipoprotein B (ApoB) between colorectal NET patients and healthy controls matched by age and sex were compared. In addition, the association of clinicopathological characteristics and follow-up data with FFA, HDL-C and FFA/HDL-C was analysed.Results: FFA was overexpressed (0.55±0.23 vs. 0.48±0.11, P= 0.006), and HDL-C was underexpressed (1.31±0.41 vs. 1.41±0.29, P=0.046) in colorectal NETs. FFA ≥0.52 mmol/L predicted lymph node metastasis (LNM) (P=0.015), HDL-C ≤1.0 mmol/L predicted tumour size ≥2 cm (P=0.017), and FFA/HDL-C>0.75 predicted tumour grade (P=0.030), LNM (P=0.014), and tumour size(P=0.018). No significant association was found between FFA and tumour grade (P=0.613) or HDL-C and tumour grade (P=0.594) or FFA and tumour size (P=0.142) or HDL-C and LNM (P=0.443). FFA ≥0.52 mmol/L (P=0.014) and HDL-C ≤1.0 mmol/L predicted worse overall survival (OS) (P=0.019). FFA/HDL-C predicted an even worse prognosis in terms of OS (P<0.001).Conclusion: FFA ≥0.52 mmol/L HDL-C ≤1.0 mmol/L and FFA/HDL-C>0.75 were promising cut-off values in predicting LNM, tumour size and worse OS in colorectal NETs.

Nonlinear Relationship of Non-High-Density Lipoprotein Cholesterol and Cognitive Function in American Elders: A Cross-Sectional NHANES Study (2011–2014)

Background: Serum non-high-density lipoprotein-cholesterol (non-HDL-C) levels may be associated with cognitive function. Objective: The objective of this study was to evaluate the association between non-HDL-C and cognitive function among American elders. Methods: We used data from the 2011 to 2014 U.S. National Health and Nutrition Examination Survey (NHANES). A total of 3,001 participants aged over 60 years were enrolled in our analysis. The cognitive function was evaluated with the word learning subtest from the Consortium to Establish a Registry for Alzheimer’s disease (CERAD W-L), the Animal Fluency Test (AFT), and the digit symbol substitution test (DSST). We also created a composite cognitive z-score to represent a global cognition. We applied multivariate linear regression analyses to estimate the associations between non-HDL-C levels and all domains of cognitive function. Further, the generalized additive model and the smooth curve were conducted to investigate the dose-response relationship between non-HDL-C and global cognition. Results: Serum non-HDL-C was positively associated with global cognition (β= 0.20, 95% CI: 0.11, 0.28), AFT score (β= 0.54, 95% CI: 0.33, 0.76), and DSST score (β= 1.13, 95% CI: 0.56, 1.69) after fully adjusted. While non-HDL-C was not related to CERAD W-L score. In addition, an inverted U-shape curve was observed in the dose-response relationship between non-HDL-C and global cognition (p for non-linearity < 0.001). Conclusion: Serum non-HDL-C is positively and nonlinearly associated with cognitive function among American older adults. Maintaining serum cholesterol levels at an appropriate range may be helpful to the cognitive health of the elderly.

Lipid profile an important risk factor in patients with ovarian tumors: a meta-analysis

Introduction: In the literature ovarian tumors are knowed to be one of the most deadliest gynecological malignancies [1-4]. In US this type of malignancy represents 2.3 % of all cancer-related death and about 4 % of all new cancer cases among women. There are several studies that have reported the role of lipid profiles and it’s role in ovarian tumorigenesis. Fatty acids are essential for cancer cells progression[4-8]. In our study we investigated the true differance in circulating lipid profiles (total cholesterol TC, triglyceride TG, high-density lipoprotein cholesterol HDL, low density lipoprotein cholesterol LDL) among patients with and without ovarian tumors (OT) using a meta-analytical approach. Mehods: The meta-analysis was conducted using the MOOSE guidelines. PubMed, EMBASE and Cochrane Library were extensively searched ( with a period of publication restriction between 2007 and 2019) to indetify published studies using the following keywords: “ total cholesterol ”, “high-density lipoprotein”, “ triglycerides ”, “ low-density lipoprotein ”, “ ovarian cancer”, “ ovarian tumor ”, “ lipid profile ”. The search methodology is shown in Fig. 1 and all references of retrieved articles were searched manually. Results: Seven studies, involving 1542 OT cases and 2195 non-cases of OT were included in this meta-analysis and I² statistics ranged between 97 and 99%. Mean circulating TC and HDL were significantly lower among OT cases compared to non-OT cases (P<0.04 and P<0.005). Conclusion: There is a modest significant association between circulating HDL and risk of ovarian tumor but it is crucial to elucidate the implications of HDL in tumor manifestations and growth.

Lipid Profile an Important Risk Factor in Patients with Ovarian Tumors: A-Meta-Analysis

Introduction In the literature ovarian tumors are know to be one of the deadliest gynecological malignancies [1-4]. In US this type of malignancy represents 2.3 % of all cancer-related death and about 4 % of all new cancer cases among women. There are several studies that have reported the role of lipid profiles and it’s role in ovarian tumorigenesis. Fatty acids are essential for cancer cells progression[4-8]. In our study we investigated the true differance in circulating lipid profiles (total cholesterol TC, triglyceride TG, high-density lipoprotein cholesterol HDL, low density lipoprotein cholesterol LDL) among patients with and without ovarian tumors (OT) using a meta-analytical approach. Methods The meta-analysis was conducted using the MOOSE guidelines. PubMed, EMBASE and Cochrane Library were extensively searched (with a period of publication restriction between 2007 and 2019) to indentify published studies using the following keywords: “ total cholesterol ”, “high-density lipoprotein”, “ triglycerides ”, “ low-density lipoprotein ”, “ ovarian cancer”, “ ovarian tumor ”, “ lipid profile ”. The search methodology is shown in Fig. 1 and all references of retrieved articles were searched manually. Results Seven studies, involving 1542 OT cases and 2195 non-cases of OT were included in this meta-analysis and I² statistics ranged between 97 and 99%. Mean circulating TC and HDL were significantly lower among OT cases compared to non-OT cases (P<0.04 and P<0.005). Conclusion There is a modest significant association between circulating HDL and risk of ovarian tumor but it is crucial to elucidate the implications of HDL in tumor manifestations and growth.

The Association Between Diabetes Coexisting With Low Levels of High-density Lipoprotein Cholesterol and Peritoneal Dialysis-related Peritonitis

BackgroundLow levels of high-density lipoprotein-cholesterol (HDL-C) and diabetes are common in patients undergoing peritoneal dialysis (PD). The aim of this study was to investigate the association between diabetes coexisting with a low level of HDL-C and the first episode of peritoneal dialysis-related peritonitis (PDRP) in patients with PD.MethodsWe retrospectively investigated patients with PD from January 1, 2003, to May 31, 2020 in four PD centers. Patients with PD were divided into four groups: no comorbidity, low HDL-C only, diabetes only, and diabetes plus low HDL-C. The clinical and laboratory baseline data of the four groups were collected and compared. The association between diabetes coexisting with low HDL-C levels and the first episode of PDRP was analysed by multivariate Cox regression analysis. ResultsA total of 1013 patients with PD were recorded in our study. The mean age was 49.94±14.32 years, and 597 (58.99%) were males. A total of 301 (29.7%) patients had their first episodes of PDRP, and low HDL-C levels existed with diabetes in 72 patients with PD. After adjusting for confounding factors, a low level of HDL-C coexisting with diabetes was significantly associated with the first episode of PDRP in our study (hazard ratio: 1.93, 95% CI: 1.03-3.61, p<0.05). The associations between HDL-C, diabetes and PDRP were consistent in the following subgroups: sex, age, pre-existing CVD (all P interaction > 0.05).ConclusionsLow levels of HDL-C alone or diabetes alone were not independent risk factors for PDRP. Patients with both diabetes and low HDL-C levels were at high risk for PDRP.

Comparison of the Diagnostic Value Between Triglyceride-Glucose Index and Triglyceride-to-High Density Lipoprotein Cholesterol Ratio in MAFLD Patients: A Retrospective Cross-Sectional Study

Background The triglyceride and glucose index (TyG) and triglyceride-to-high density lipoprotein cholesterol ratio (TG/HDL-C) were found to be substitute markers of insulin resistance (IR). We aimed to compare the efficacy of the two indicators in the diagnosis of Metabolic-Associated Fatty Liver Disease (MAFLD), which was rarely covered in the literature, and to construct a novel disease diagnosis model.Methods A retrospective cross-sectional study was carried out in West China Hospital of Sichuan University and 229 people (97 MAFLD and 132 Non-MAFLD) were included. Biochemical indexes were collected and analyzed by logistic regression to screen out indicators that expressed differently in MAFLD patients and healthy controls and incorporate them into a diagnostic model. MAFLD was diagnosed by Ultrasound.Results After adjusting for age, gender and BMI, Serum ALT, AST, AST/ALT (A/A), FPG, Cys-C, URIC, TG, HDL-C, ALP, GGT, nonHDL-C, LDL-C/HDL-C, nonHDL-C/HDL-C, TG/HDL-C, TC/HDL-C, TyG and TyG-BMI were risk factors of MAFLD through binary logistics regression analysis. The odds ratio of TG/HDL-C and TyG were 5.387 (95%CI: 2.986-9,718) and 107.945 (95% CI: 25.824-451.222). In identifying MAFLD, TyG, TG/HDL-C and TG were found to be the most vital indexes by the random forest method and the area under the curve (AUC) of them are all greater than 0.9 respectively. In addition, the combination of gender, BMI, ALT, TG, HDL-C, TyG and TyG-BMI had a great diagnostic efficiency for MAFLD.Conclusions TyG and TG/HDL-C were potential risk factors for MAFLD and the former made a better performance in diagnosing MAFLD. The combination of gender, BMI, ALT, TG, HDL-C, TyG and TyG-BMI improved the diagnostic capability of MAFLD.