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Triglyceride–to–High-Density-Lipoprotein-Cholesterol Ratio Is an Index of Heart Disease Mortality and of Incidence of Type 2 Diabetes Mellitus in Men
  1. Gloria Lena Vega, PhD*,
  2. Carolyn E. Barlow, MS,
  3. Scott M. Grundy, MD, PhD*,
  4. David Leonard, PhD,
  5. Laura F. DeFina, MD
  1. From the *Center for Human Nutrition, University of Texas Southwestern Medical Center, the Veterans Affairs Medical Center at Dallas; and †The Cooper Institute, Dallas, TX.
  1. Received July 3, 2013, and in revised form August 6, 2013.
  2. Accepted for publication August 6, 2013.
  3. Reprints: Gloria Lena Vega, PhD, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390; or Laura F. DeFina, MD, Center for Human Nutrition, The Cooper Institute, 12330 Preston Rd, Dallas, TX 75230. E-mail: Gloria.Vega{at}; Ldefina{at}
  4. This study was supported in part by grant UL1TR000451 from the National Center for Advancing Translational Sciences, National Institutes of Health (to S.M.G. and G.L.V.)


Background High triglyceride (TG) and low high-density lipoprotein cholesterol (HDL-C) impart risk for heart disease. This study examines the relationships of TG/HDL-C ratio to mortality from all causes, coronary heart disease (CHD), or cardiovascular disease (CVD).

Subjects and Methods Survival analysis was done in 39,447 men grouped by TG/HDL-C ratio cut point of 3.5 and for metabolic syndrome. National Death Index International Classification of Diseases (ICD-9 and ICD-10) codes were used for CVD and CHD deaths occurring from 1970 to 2008. Incidence of type 2 diabetes mellitus (DM) according to ratio was estimated in 22,215 men. Triglyceride/HDL-C ratio and cross-product of TG and fasting blood glucose (TyG index) were used in analysis.

Results Men were followed up for 581,194 person-years. Triglyceride/HDL-C ratio predicted CHD, CVD, and all-cause mortality after adjustment for established risk factors and non–HDL-C. Mortality rates were higher in individuals with a high ratio than in those with a low ratio. Fifty-five percent of men had metabolic syndrome that was also predictive of CHD, CVD, and all-cause mortality. Annual incidence of DM was 2 times higher in men with high TG/HDL-C ratio than in those with a low ratio. Individuals with high TG/HDL-C ratio had a higher incidence of DM than those with a low ratio. The TyG index was not equally predictive of causes of mortality to TG/HDL-C, but both were equally predictive of diabetes incidence.

Conclusions Triglyceride/HDL-C ratio predicts CHD and CVD mortality as well as or better than do metabolic syndrome in men. Also, a high ratio predisposes to DM. The TyG index does not predict CHD, CVD, or all-cause mortality equally well, but like TG/HDL-C ratio, it predicts DM incidence.

Key Words
  • TG/HDL-C ratio
  • CVD mortality
  • CHD mortality

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