Triglyceride/HDL cholesterol ratio and lipoprotein insulin resistance Score: Associations with subclinical atherosclerosis and incident cardiovascular disease

José L Flores-Guerrero; Riemer A Been; Irina Shalaurova; Margery A Connelly; Peter R van Dijk; Robin P F Dullaart

doi:10.1016/j.cca.2023.117737

Triglyceride/HDL cholesterol ratio and lipoprotein insulin resistance Score: Associations with subclinical atherosclerosis and incident cardiovascular disease

Clin Chim Acta. 2024 Jan 15:553:117737. doi: 10.1016/j.cca.2023.117737. Epub 2023 Dec 22.

Authors

José L Flores-Guerrero¹, Riemer A Been², Irina Shalaurova³, Margery A Connelly³, Peter R van Dijk⁴, Robin P F Dullaart²

Affiliations

¹ Interdisciplinary Center for Research and Science Education, Autonomous University of Puebla, Puebla, Mexico.
² Department of Internal Medicine, Division of Endocrinology, University Medical Center Groningen, University of Groningen, the Netherlands.
³ Labcorp, Morrisville, NC, 27560, USA.
⁴ Department of Internal Medicine, Division of Endocrinology, University Medical Center Groningen, University of Groningen, the Netherlands. Electronic address: p.r.van.dijk@umcg.nl.

PMID: 38142802
DOI: 10.1016/j.cca.2023.117737

Abstract

Background: The triglyceride/HDL cholesterol (TG/HDL-C) ratio and the Lipoprotein Insulin Resistance (LP-IR) score are lipid markers of insulin resistance. Their associations with carotid intima media thickness (cIMT; subclinical atherosclerosis) and incident cardiovascular disease (CVD) have not been thoroughly investigated.

Methods: In a cross-sectional cohort (89 subjects without type 2 diabetes (T2D) and 81 subjects with T2D we determined cIMT (ultrasound), homeostasis model assessment of insulin resistance (HOMA-IR) and the TG/HDL-C ratio. The LP-IR score, based on 6 lipoprotein characteristics determined by nuclear magnetic resonance spectroscopy, was measured in 123 participants. A prospective study was carried out among 6232 participants (Prevention of REnal and Vascular ENd-stage Disease study).

Results: Cross-sectionally, the adjusted associations of HOMA-IR, the TG/HDL-C ratio and the LP-IR score with cIMT were approximately similar (standardized β = 0.34 (95 % CI 0.19-0.48), 0.24 (95 % CI 0.09-039) and 0.41 (95 % CI 0.23--0.59), respectively). Prospectively, 507 new cases of CVD were observed after a median follow-up of 8.2 (interquartile range 7.5-8.8) years. HOMA-IR, the TG/HDL-C ratio and LP-IR were each associated with incident CVD independent of potential confounders (HR 1.12, 95 % CI 1.02-1.24;1.22, 95 % CI 1.11-1.35 and 1.15. 95 % CI 1.01-1.31, respectively). The association of the TG/HDL-C ratio with incident CVD was somewhat stronger than that of HOMA-IR.

Conclusion: Lipoprotein-based markers of insulin resistance are at least as strongly associated with subclinical atherosclerosis and clinical atherosclerosis development as HOMA-IR, obviating the need to measure insulin to determine the impact of insulin resistance. For practical purposes, the easily obtainable TG/HDL-C ratio may suffice.

Keywords: Carotid intima media thickness; HOMA-IR; Incident cardiovascular disease; Lipoprotein Insulin Resistance score; Type 2 diabetes; triglyceride/HDL cholesterol ratio.

Publication types

Case Reports

MeSH terms

Atherosclerosis* / diagnosis
Cardiovascular Diseases* / diagnosis
Carotid Intima-Media Thickness
Cholesterol, HDL
Cross-Sectional Studies
Diabetes Mellitus, Type 2*
Humans
Insulin Resistance*
Lipoproteins
Prospective Studies
Triglycerides

Substances

Cholesterol, HDL
Lipoproteins
Triglycerides