Letter to the Editor
Triglycerides-to-HDLC Ratio as a Marker of Cardiac Disease and Vascular Risk Factors in Adults
Erkan Cure1, Medine Cumhur Cure2
- Department of Internal Medicine, Ota & Jinemed Hospital, Besiktas, Istanbul, Turkey
- Department of Biochemistry, Private Practice, Besiktas, Istanbul, Turkey
We read with great interest, the study evaluating the triglycerides (TG)-to-high density lipoprotein cholesterol (HDL-C) ratio as a marker of cardiac disease and vascular risk factors in adults by Ain et al.1 We would like to draw attention to very important points in that study.
- In that study, the standard deviations of the TG/HDLC, the quantitative insulin sensitivity check index (Quicki), and homeostasis model assessment of insulin resistance (Homa-IR) levels are too large. All the groups, which do not show homogeneous distribution for these parameters, must be given as median (range). The authors should use the Mann-Whitney U-test and Kruskal-Wallis tests instead of the one-way Anova test, compared to non-homogeneous data. P values may change with accurate statistical evaluation.
- In that study, patients were divided into three groups according to TG/HDL-C values. Interestingly, the body mass index (BMI) value of Group 1 is significantly higher than in the other two groups. Homa-IR value of Group 1 was lower than other Groups; whereas, the whole-body insulin sensitivity index (WBISI) value was higher than the two Groups. Abrams et al. reported that an 8% decrease in BMI causes an important improvement in WBISI.2 A strong positive correlation between BMI with TG/HDL ratio and Homa-IR values is also known.3 If there was a positive or negative relationship between TG/HDL values and other all parameters, it should be evaluated by proper correlation analysis.1
- The skeletal muscle mass (SMM) value of Group 1 was higher than the other two Groups, and the visceral fat tissue value of Group 1 was slightly lower than the other two groups.1 Does such a high BMI level in Group 1 depends exclusively on muscle mass? Were these patients doing bodybuilding? Or are there inconsistencies in their results? The waist circumference of the patients should be given in the results section.
- Recently the atherogenic, index of plasma (AIP, log [TG/HDL-C]) value has become a more popular index than the TG/HDL value.4 A previous study reported that a higher AIP level was positively and strongly related to obesity.5 AIP has been reported to be a novel and better marker for heart disease risk, obesity and insulin sensitivity than the TG/HDL ratio.4,5 The authors could evaluate the more popular AIP value in that study rather than the TG/HDL ratio.
CONFLICT OF INTEREST:
Authors declared no conflict of interest.
EC, MCC: Literature search and writing.
- Ain QU, Asif N, Alam A, Gilani M, Noreen Shahzad, Sheikh W. Triglycerides-to-HDLC ratio as a marker of cardiac disease and vascular risk factors in adults. J Coll Physicians Surg Pak 2019; 29(11):1034-7. doi: 10.29271/ jcpsp.2019.11.1034.
- Abrams P, Levitt Katz LE, Moore RH, Xanthopoulos MS, Bishop-Gilyard CT. Threshold for improvement in insulin sensitivity with adolescent weight loss. J Pediatr 2013; 163(3):785-90. doi: 10.1016/j.jpeds.2013.04.003.
- Borrayo G, Basurto L, González-Escudero E, Diaz A, Vázquez A, Sánchez L, Hernández-González GO, et al. TG/HDL-C ratio as cardio-metabolic biomarker even in normal weight women. Acta Endocrinol (Buchar) 2018; 14(2):261-7. doi: 10.4183/aeb.2018.261.
- Dobiasova M. Atherogenic index of plasma [log(triglycerides/HDL-cholesterol)]: Theoretical and practical implications. Clin Chem 2004; 50(7):1113-5. doi: 10.1373/clinchem.2004.033175.
- Zhu X, Yu L, Zhou H, Ma Q, Zhou X, Lei T, et al. Atherogenic index of plasma is a novel and better biomarker associated with obesity: A population-based cross-sectional study in China. Lipids Health Dis 2018; 17:37. doi: 10.1373/clinchem.2004.033175.