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Use of the triglyceride/high-density lipoprotein cholesterol ratio to identify cardiometabolic risk: impact of obesity?
  1. M R Salazar1,2,
  2. H A Carbajal2,
  3. W G Espeche1,2,
  4. M Aizpurúa3,
  5. A G Marillet4,
  6. C E Leiva Sisnieguez1,2,
  7. B C Leiva Sisnieguez1,2,
  8. R N Stavile1,2,
  9. C E March1,2,
  10. G M Reaven5
  1. 1Hospital Universitario General San Martín, La Plata, Argentina
  2. 2Facultad de Ciencias Médicas, UNLP, La Plata, Argentina
  3. 3Hospital Municipal de Rauch, Buenos Aires, Argentina
  4. 4Hospital Municipal de San Andrés de Giles, Buenos Aires, Argentina
  5. 5Stanford University School of Medicine, Stanford, California, USA
  1. Correspondence to Dr MR Salazar, Hospital Universitario General San Martín, 14 n 320, La Plata, Buenos Aires 1900, Argentina; salazarlandea{at}


There is evidence that the plasma concentration ratio of triglyceride (TG)/high-density lipoprotein cholesterol (HDL-C) identifies insulin resistance and increased cardiometabolic risk and outcome in apparently healthy individuals. Since use of the TG/HDL-C ratio to accomplish this task in persons over a wide range of adiposity has not been studied, the ability of previously defined sex-specific TG/HDL-C cut-points to identify increased cardiometabolic risk was evaluated in apparently healthy normal weight, overweight, and obese individuals. Data were analyzed from a population-based study of apparently healthy men (n=416) and women (n=893), subdivided into categories by body mass index (BMI, kg/m2): normal weight (BMI 20.0–24.9), overweight (BMI 25.0–29.9) and obese (BMI 30.0–34.9). The adiposity groups were further stratified on the basis of their TG/HDL-C ratio into groups defined as being either at ‘high risk’ versus ‘low risk’ of cardiometabolic disease. Multiple cardiometabolic risk factors were compared between these subgroups, as was their degree of insulin resistance assessed by fasting plasma insulin concentration and homeostasis model assessment of insulin resistance. The proportion of high-risk individuals varied with BMI category, ranging from 14% (normal weight) to 36% (obese). However, within each BMI category high-risk individuals had a significantly more adverse cardiometabolic risk profile. Finally, the adjusted OR of being insulin resistant was significantly greater in those with a high TG/HDL-C ratio in the normal (3.02), overweight (2.86), and obese (2.51) groups. Thus, irrespective of differences in BMI, the TG/HDL-C ratio identified apparently healthy persons with a more adverse cardiometabolic risk profile associated with an increased prevalence of insulin resistance.

  • Obesity
  • Insulin
  • Cardiovascular Diseases

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  • Contributors HAC and MRS performed the design of both projects, RAUCH and PROCER. GMR, MRS and HAC performed the study design. MA was involved in epidemiological survey in Rauch. AGM was involved in epidemiological survey in San Andrés de Giles. CEM, RNS and WGE were involved in Rauch’s data collection and analysis. CELS and BCLS were involved in San Andrés de Giles’s data collection and analysis. CELS, BCLS, RNS and CEM were involved in initial manuscript written. GMR, HAC, WGE and MRS were involved in final version and manuscript revision. All the authors approved the final version.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.