The triglyceride/HDL cholesterol (TG/HDL-C) ratio is a clinical but simple and cheap marker increasingly used to evaluate metabolic and especially cardiac health.
TG/HDL and Cardiovascular Health
Many publications indicate that the TG/HDL-C ratio may be one of the best readily available markers for predicting potential cardiovascular outcomes, much better than the always-popular total cholesterol, LDL or HDL ratio.
In the study conducted by Sultani et al., the results indicated that elevated TG/HDL-C ratios were associated with a worse long-term prognosis in patients with a high clinical suspicion of coronary artery disease (CAD). Specifically, those in the higher TG/HDL-C ratio group (over 2.5) exhibited a 2.10 times greater propensity for all-cause mortality and a 2.72 times greater propensity for experiencing major adverse cardiac events over the follow-up period. (1)
In study by C. Caselli et al. those in the highest TG/HDL-C ratio group experienced more than two times a cardiovascular event compared to those in the lowest quartile. (2)
Similarly, Iranian men in the top quartile of TG/HDL-C experienced new CHD events 1.75 times more compared to the first quartile. (3)
In turn, in women, high TG/HDL-C ratio (first quartile 0.35 to 1.4, fourth quartile 3.66-18.4) was associated with a hazard ratio of 1.95 for mortality, and 1.54 for cardiovascular events, after adjustments. (4)
T. de Giorgis et al. suggested that the TG/HDL ratio can already be used in children, pointing to the first signs of vascular damage observed through increased carotid intima-media thickness. They concluded: “This study confirms the reliability of the TG/HDL-C ratio as a useful marker of cardiovascular risk. Interestingly, our results underline that the TG/HDL-C ratio is directly related with early signs of vascular damage already present in prepubertal children.” (5)
TG/HDL and Metabolic health
The ratio of triglycerides to HDL is also considered a good indicator of metabolic health, well correlated with the presence of insulin resistance, metabolic syndrome or diabetes.
In a polish study on children by Krawczyk et al. a higher TG/HDL-C ratio, with each unit increase, was associated with a 2.09-fold increase in the odds of developing metabolic syndrome. The researchers concluded: “When comparing the usefulness of some IR markers in prediction of the metabolic syndrome, the TG/HDL-C ratio seems to be the best one and should be used in clinical practice to identify children at risk of metabolic syndrome development.” (6)
In turn, in both Hispanic and African American populations TG/HDL-C ratio was associated with insulin resistance and predicted incident type 2 diabetes in women. (7)
In a study on children and adolescents researchers found there was a progressive increase in body mass index (BMI), waist circumference, blood pressure (BP), liver enzymes, glucose, insulin, homeostasis model assessment of insulin resistance, high-sensitivity C-reactive protein (hsCRP), and morphological vascular changes such as increased carotid artery intima-media thickness (cIMT) values across TG/HDL-C tertiles. (8)
TG/HDL ratio can be used for the initial identification of fatty liver, see "Silent Killer? 7 Early Warning Symptoms of Metabolic Syndrome You Can't Ignore”
TG/HDL ratio usually correlates with another good marker of heart health, remnant cholesterol, see "Remnant Cholesterol | Calculator."
Bottom line
The TG/HDL ratio in a growing number of publications is proving to be one of the best markers of metabolic health and consequently cardiovascular health. It is simple, readily affordable and seems to be much more accurate than many traditional markers.