Associations Between Triglyceride/High-Density Lipoprotein Cholesterol Ratio and Micro- and Macroangiopathies in Type 2 Diabetes Mellitus

Mei-Yueh Lee, MD; Pi-Jung Hsiao, MD; Jiun-Chi Huang, MD; Wei-Hao Hsu, MD; Szu-Chia Chen, MD, PhD; Jer-Ming Chang, MD, PhD; Shyi-Jang Shin, MD, PhD

Disclosures

Endocr Pract. 2018;24(7):615-621. 

In This Article

Abstract and Introduction

Abstract

Objective: The triglyceride (TG) to high-density lipoprotein cholesterol (HDL-C) ratio has been reported to be a marker of insulin resistance. The aim of this study was to investigate associations between the TG/HDL-C ratio and micro- and macroangiopathies in patients with type 2 diabetes mellitus (DM).

Methods: A total of 1,981 (851 male and 1,130 female) patients with type 2 DM were enrolled from our outpatient clinic. These patients were stratified into 4 groups according to TG/HDL-C ratio quartiles.

Results: There were significant trends for stepwise increases in albuminuria ≥30 mg/g (P<.001), coronary artery disease (CAD, P = .040), cerebrovascular disease (CVA, P = .002) and ankle-brachial index (ABI) <0.9 (P = .001) corresponding to TG/HDL-C ratio quartiles, but not diabetic retinopathy (P = .105). Furthermore, quartile 4 of the TG/HDL-C ratio was significantly associated with albuminuria, CAD, CVA, and ABI <0.9 after multivariate analysis compared to quartile 1.

Conclusion: A high TG/HDL-C ratio was significantly associated with albuminuria, CAD, CVA, and peripheral artery occlusive disease (PAOD) in patients with DM, which translated into an increased risk of cardiovascular disease.

Introduction

The prevalence of type 2 diabetes mellitus (DM) is increasing worldwide. The morbidity and mortality associated with DM are mainly caused by micro- and macrovascular complications and include diabetic retinopathy (DR), diabetic nephropathy, diabetic neuropathy, coronary artery disease (CAD), cerebrovascular disease (CVA), and peripheral artery occlusive disease (PAOD). Furthermore, vascular complications are the leading cause of end-stage renal disease, acquired blindness, various neuropathies, and advanced atherosclerosis in patients with diabetes.[1] Known risk factors for micro- and macrovascular complications include poor glycemic control, duration of DM, hypertension, insulin resistance and dyslipidemia.[2–5] Aggressive control of both blood glucose and blood pressure can potentially be beneficial in the prevention of micro- and macroangiopathies in patients with DM, however this is often difficult due to the associated risks of hypoglycemia and hypotension.[6,7] Therefore, identifying other targets and treatments to slow the development of micro- and macroangiopathies in patients with type 2 DM is an important issue.

Dyslipidemia, and especially increased levels of triglycerides (TGs) and decreased levels of high-density lipoprotein cholesterol (HDL-C), has been strongly associated with insulin resistance and type 2 DM.[8] Furthermore, recent studies have demonstrated that the TG/HDL-C ratio may be a better predictor of insulin resistance and cardiovascular disease than TG or HDL-C level alone.[9,10] The TG/HDL-C ratio has also been shown to predict the risk of cardiovascular disease in patients with disorders including coronary heart disease, hypertension, and DM.[11–13] This suggests that the TG/HDL-C ratio may be an important predictor of micro- and macroangiopathies in patients with DM. The aim of this study to investigate whether the TG/HDL-C ratio is independently associated with micro- and macroangiopathies in patients with DM in southern Taiwan.

Comments

3090D553-9492-4563-8681-AD288FA52ACE

processing....