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The relationship between triglyceride/high-density lipoprotein cholesterol ratio and the functional significance of coronary lesions

Year 2024, Volume: 5 Issue: 3, 149 - 154, 28.06.2024

Can Özkan

https://doi.org/10.47582/jompac.1469728

Abstract

Aims: Have shown that triglycerides (TG) are an independent risk factor for cardiovascular disease (CVD). Dyslipidemia characterized by low high-density lipoprotein cholesterol (HDL-C) has been shown to be associated with symptoms of coronary artery disease (CAD). In studies, the TG/HDL-C ratio has been found to be strongly associated with parameters indicative of the severity of coronary disease. In this study, we aimed to investigate whether the TG/HDL-C ratio is associated with the functional significance of moderate coronary artery lesions.
Methods: A total of 102 consecutive patients, 72 male and 30 female, who underwent measurement of fractional flow reserve (FFR) due to moderate coronary stenosis (quantitative coronary analysis 40-70%) on angiography were included in the study. An FFR value ≤0.80 was accepted for hemodynamic significance.
Results: Among the 102 patients included in the study, it was determined that 52 (50.9%) had significant functional stenosis. Left ventricular ejection fraction of Group II was lower than Group I (60 (55-62.5) vs. 55(50-60), p=0.006). The male patient ratio was higher in Group II, but the difference between the two groups was not significant (68% and 77%, respectively, p=0.072). Univariate and multivariate logistic regression analysis showed that TG/HDL-C (OR=1.278, 95% CI=1.078-1.514, p=0.005) was an independent determinant of significant functional stenosis. ROC analysis revealed that the TG/HDL-C value was 3.89 and provided 64% specificity and 61.5% sensitivity in predicting hemodynamically significant coronary artery stenosis.
Conclusion: Elevated TG/HDL-C values are associated with the functional significance of angiographically moderate coronary artery stenosis.

Keywords

Coronary Artery Disease Triglyceride Fractional Flow Reserve HDL-C

References

  • Spadaccio C, Glineur D, Barbato E, et al. Fractional Flow reserve–based coronary artery bypass surgery. JACC Cardiovasc Interv. 2020;13(9):1086-1096.
  • Korkmaz A, Demir M, Unal S, et al. Monocyte-to-high density lipoprotein ratio (MHR) can predict the significance of angiographically intermediate coronary lesions. Int J Cardiovasc Acad. 2017;3(1-2):16-20.
  • Fearon WF, Zimmermann FM, De Bruyne B, et al. Fractional flow reserve-guided PCI as compared with coronary bypass surgery. N Engl J Med. 2022;386(2):128-137. 
  • Boutaleb AM, Ghafari C, ungureanu c, carlier s. fractional flow reserve and non-hyperemic indices: essential tools for percutaneous coronary interventions. World J Clin Cases. 2023; 11(10):2123-2139.
  • Harchaoui KE, Visser ME, Kastelein JJ, Stroes ES, Dallinga-Thie GM. Triglycerides and cardiovascular risk. Curr Cardiol Rev. 2009;5(3):216-222.
  • Asakura K, Minami Y, Kinoshita D, et al. Impact of triglyceride levels on plaque characteristics in patients with coronary artery disease. Int J Cardiol. 2022;348:134-139.
  • Gianturco SH, Bradley WA, Gotto AM Jr, Morrisett JD, Peavy DL. Hypertriglyceridemic very low density lipoproteins induce triglyceride synthesis and accumulation in mouse peritoneal macrophages. J Clin Invest. 1982;70(1):168-178.
  • McBride P. Triglycerides and risk for coronary artery disease. Curr Atheroscler Rep. 2008;10(5):386-390.
  • Annema W, von Eckardstein A. Dysfunctional high-density lipoproteins in coronary heart disease: implications for diagnostics and therapy. Transl Res. 2016;173:30-57.
  • Guo X, Ma L. Inflammation in coronary artery disease-clinical implications of novel HDL-cholesterol-related inflammatory parameters as predictors. Coron Artery Dis. 2023;34(1):66-77.
  • Li F, Li X, Zhou J, et al. Triglyceride to high-density lipoprotein cholesterol ratio associated with long-term adverse clinical outcomes in patients deferred revascularization following fractional flow reserve. Lipids Health Dis. 2024;23(1):96.
  • Tobis J, Azarbal B, Slavin L. Assessment of intermediate severity coronary lesions in the catheterization laboratory. J Am Coll Cardiol. 2007;49(8):839-848.
  • Pijls NH, Sels JW. Functional measurement of coronary stenosis. J Am Coll Cardiol. 2012;59(12):1045-1057.
  • Nogic J, Prosser H, O’Brien J, et al. The assessment of intermediate coronary lesions using intracoronary imaging. Cardiovasc Diagn Ther. 2020;10(5):1445-1460.
  • Koo BK, Hu X, Kang J, et al. Fractional flow reserve or intravascular ultrasonography to guide PCI. N Engl J Med. 2022;387(9):779-789.
  • Tonino PA, De Bruyne B, Pijls NH, et al. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med. 2009;360(3):213-224.
  • Lee JM, Kim HK, Park KH, et al. Fractional flow reserve versus angiography-guided strategy in acute myocardial infarction with multivessel disease: a randomized trial. Eur Heart J.  2023;44(6):473-484.
  • Hansson GK. Inflammation, atherosclerosis, and coronary artery disease. N Engl J Med. 2005;352(16):1685-1695.
  • Hilgendorf I, Swirski FK, Robbins CS. Monocyte fate in atherosclerosis. Arterioscler Thromb Vasc Biol. 2015;35(2):272-279. 
  • St-Pierre AC, Cantin B, Dagenais GR, et al. Low-density lipoprotein subfractions and the long-term risk of ischemic heart disease in men: 13-year follow-up data from the Québec Cardiovascular Study. Arterioscler Thromb Vasc Biol. 2005;25(3):553-559.
  • Mikhailidis DP, Elisaf M, Rizzo M, et al. “European panel on low density lipoprotein (LDL) subclasses”: a statement on the pathophysiology, atherogenicity and clinical significance of LDL subclasses. Curr Vasc Pharmacol. 2011;9(5):533-571.
  • Varbo A, Benn M, Tybjærg-Hansen A, Jørgensen AB, Frikke-Schmidt R, Nordestgaard BG. Remnant cholesterol as a causal risk factor for ischemic heart disease. J Am Coll Cardiol. 2013;61(4):427-436.
  • Hoogeveen RC, Gaubatz JW, Sun W, et al. Small dense low-density lipoprotein-cholesterol concentrations predict risk for coronary heart disease: the Atherosclerosis Risk In Communities (ARIC) study. Arterioscler Thromb Vasc Biol. 2014;34(5):1069-1077.
  • Langsted A, Freiberg JJ, Tybjaerg-Hansen A, Schnohr P, Jensen GB, Nordestgaard BG. Nonfasting cholesterol and triglycerides and association with risk of myocardial infarction and total mortality: the Copenhagen City Heart Study with 31 years of follow-up. J Intern Med. 2011;270(1):65-75.
  • Quispe R, Manalac RJ, Faridi KF, et al. Relationship of the triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio to the remainder of the lipid profile: The Very Large Database of Lipids-4 (VLDL-4) study. Atherosclerosis. 2015;242(1):243-250.
  • Triglyceride Coronary Disease Genetics Consortium and Emerging Risk Factors Collaboration, Sarwar N, Sandhu MS, et al. Triglyceride-mediated pathways and coronary disease: collaborative analysis of 101 studies. Lancet. 2010;375(9726):1634-1639.
  • Murphy AJ, Woollard KJ. High-density lipoprotein: a potent inhibitor of inflammation. Clin Exp Pharmacol Physiol. 2010; 37(7):710-718. 
  • Murphy AJ, Chin-Dusting JP, Sviridov D, Woollard KJ. The anti inflammatory effects of high density lipoproteins. Curr Med Chem. 2009;16(6):667-675.
  • Hessler JR, Robertson AL Jr, Chisolm III GM. LDL-induced cytotoxicity and its inhibition by HDL in human vascular smooth muscle and endothelial cells in culture. Atherosclerosis. 1979;32(3):213-229.
  • Li XP, Zhao SP, Zhang XY, Liu L, Gao M, Zhou QC. Protective effect of high density lipoprotein on endothelium-dependent vasodilatation. Int J Cardiol. 2000;73(3):231-236.
  • Kuvin JT, Rämet ME, Patel AR, Pandian NG, Mendelsohn ME, Karas RH. A novel mechanism for the beneficial vascular effects of high-density lipoprotein cholesterol: enhanced vasorelaxation and increased endothelial nitric oxide synthase expression. Am Heart J. 2002;144(1):165-172.
  • van de Woestijne AP, van der Graaf Y, Liem AH, et al. Low high-density lipoprotein cholesterol is not a risk factor for recurrent vascular events in patients with vascular disease on intensive lipid-lowering medication. J Am Coll Cardiol. 2013;62(20):1834-1841.
  • Che B, Zhong C, Zhang R, et al. Triglyceride-glucose index and triglyceride to high-density lipoprotein cholesterol ratio as potential cardiovascular disease risk factors: an analysis of UK biobank data. Cardiovasc Diabetol. 2023;22(1):34.
  • Dobiásová M, Frohlich J. The plasma parameter log (TG/HDL-C) as an atherogenic index: correlation with lipoprotein particle size and esterification rate in apoB-lipoprotein-depleted plasma (FER(HDL)). Clin Biochem. 2001;34(7):583-588.
  • Shao QY, Ma XT, Yang ZQ, et al. Prognostic significance of multiple triglycerides-derived metabolic indices in patients with acute coronary syndrome. J Geriatr Cardiol. 2022;19(6):456-468.
  • Su YM, Zhang R, Xu RF, et al. Triglyceride to high-density lipoprotein cholesterol ratio as a risk factor of repeat revascularization among patients with acute coronary syndrome after first-time percutaneous coronary intervention. J Thorac Dis. 2019;11(12):5087-5095.
  • Kundi H, Korkmaz A, Balun A, et al. Is in-stent restenosis after a successful coronary stent implantation due to stable angina associated with TG/HDL-C ratio? Angiology. 2017;68(9):816-822.
  • da Luz PL, Favarato D, Faria-Neto JR Jr, Lemos P, Chagas AC. High ratio of triglycerides to HDL-cholesterol predicts extensive coronary disease. Clinics (Sao Paulo). 2008;63(4):427-432.
  • Bampi AB, Rochitte CE, Favarato D, Lemos PA, da Luz PL. Comparison of non-invasive methods for the detection of coronary atherosclerosis. Clinics (Sao Paulo). 2009;64(7):675-682.
  • Ates AH, Canpolat U, Yorgun H, et al. Total white blood cell count is associated with the presence, severity and extent of coronary atherosclerosis detected by dual-source multislice computed tomographic coronary angiography. Cardiol J. 2011;18(4):371-377.

Trigliserid/yüksek yoğunluklu lipoprotein kolesterol oranı ile koroner lezyonların fonksiyonel önemi arasındaki ilişki

Year 2024, Volume: 5 Issue: 3, 149 - 154, 28.06.2024

Can Özkan

https://doi.org/10.47582/jompac.1469728

Abstract

AMAÇ
Yapılan çalışmalarda trigliseridlerin (TG) kardiyovasküler hastalık (KVH) için bağımsız bir risk faktörü olduğunu gösterilmektedir. Düşük, yüksek yoğunluklu lipoprotein kolesterel (HDL-K) ile karakterize dislipideminin KAH belirtileriyle ilişkili olduğu gösterilmiştir. Yapılan çalışmalarda TG/HDL-K oranının, koroner hastalığın derecesi ile güçlü şekilde ilişkili parametreler olduğu saptanmıştır Bu çalışmada, TG/HDL-K oranının orta koroner arter lezyonlarının fonksiyonel önemi ile ilişkili olup olmadığını araştırmayı amaçladık.
GEREÇ ve YÖNTEM
Anjiyografik olarak orta derecede koroner darlık (kantitatif koroner analizde %40-70) nedeniyle fraksiyonel akım rezervi (FAR) ölçümü yapılan 72'i erkek, 30'sı kadın olmak üzere 102 ardışık hasta çalışmaya dahil edildi. FAR değerinin ≤ 0.80 olması hemodinamik anlamlılık için kabul edildi.
BULGULAR
Çalışmaya dahil edilen 102 hasta arasında, 52'sinin (%50.9) önemli fonksiyonel darlık olduğu belirlendi. Grup II'nin sol ventrikül ejeksiyon fraksiyonu, grup I'e göre daha düşüktü (60 (55-62.5) vs. 55(50-60), p = 0.006). Grup II'de erkek hasta oranı daha yüksekti ancak iki grup arasındaki fark anlamlı değildi (sırasıyla %68 ve %77, p = 0.072). Tek değişkenli ve çoklu lojistik regresyon analizi, TG/HDL-K'nin (OR = 1.278, %95 CI = 1.078-1.514, p = 0.005) önemli fonksiyonel darlığın bağımsız belirleyicilerinden olduğunu gösterdi. ROC analizi, TG/HDL-K değerinin 3.89 olduğunu ve hemodinamik olarak önemli koroner arter darlığını tahmin etmede %64 spesifiklik ve %61.5 duyarlılık sağladığını ortaya koydu.
SONUÇ
Yükselmiş TG/HDL-K değerleri, anjiyografik olarak orta düzey koroner arter darlığının fonksiyonel önemi ile ilişkilendirilmiştir

Keywords

Koroner Arter Hastalığı Trigliserid Fraksiyonel Akım Rezervi

Ethical Statement

Bursa Şehir Hastanesi tarafından 20.12.2023 tarihinde 2023-21/15 Karar Numarası ile onaylanan çalışma protokolü Helsinki Bildirgesi prensiplerine uygun olarak yürütülmüştür. Çalışmanın retrospektif tasarımı nedeniyle hastalardan yazılı bilgilendirilmiş onam alınamamıştır.

Supporting Institution

T.C SAĞLIK BAKANLIĞI BURSA ŞEHİR HASTANESİ

References

  • Spadaccio C, Glineur D, Barbato E, et al. Fractional Flow reserve–based coronary artery bypass surgery. JACC Cardiovasc Interv. 2020;13(9):1086-1096.
  • Korkmaz A, Demir M, Unal S, et al. Monocyte-to-high density lipoprotein ratio (MHR) can predict the significance of angiographically intermediate coronary lesions. Int J Cardiovasc Acad. 2017;3(1-2):16-20.
  • Fearon WF, Zimmermann FM, De Bruyne B, et al. Fractional flow reserve-guided PCI as compared with coronary bypass surgery. N Engl J Med. 2022;386(2):128-137. 
  • Boutaleb AM, Ghafari C, ungureanu c, carlier s. fractional flow reserve and non-hyperemic indices: essential tools for percutaneous coronary interventions. World J Clin Cases. 2023; 11(10):2123-2139.
  • Harchaoui KE, Visser ME, Kastelein JJ, Stroes ES, Dallinga-Thie GM. Triglycerides and cardiovascular risk. Curr Cardiol Rev. 2009;5(3):216-222.
  • Asakura K, Minami Y, Kinoshita D, et al. Impact of triglyceride levels on plaque characteristics in patients with coronary artery disease. Int J Cardiol. 2022;348:134-139.
  • Gianturco SH, Bradley WA, Gotto AM Jr, Morrisett JD, Peavy DL. Hypertriglyceridemic very low density lipoproteins induce triglyceride synthesis and accumulation in mouse peritoneal macrophages. J Clin Invest. 1982;70(1):168-178.
  • McBride P. Triglycerides and risk for coronary artery disease. Curr Atheroscler Rep. 2008;10(5):386-390.
  • Annema W, von Eckardstein A. Dysfunctional high-density lipoproteins in coronary heart disease: implications for diagnostics and therapy. Transl Res. 2016;173:30-57.
  • Guo X, Ma L. Inflammation in coronary artery disease-clinical implications of novel HDL-cholesterol-related inflammatory parameters as predictors. Coron Artery Dis. 2023;34(1):66-77.
  • Li F, Li X, Zhou J, et al. Triglyceride to high-density lipoprotein cholesterol ratio associated with long-term adverse clinical outcomes in patients deferred revascularization following fractional flow reserve. Lipids Health Dis. 2024;23(1):96.
  • Tobis J, Azarbal B, Slavin L. Assessment of intermediate severity coronary lesions in the catheterization laboratory. J Am Coll Cardiol. 2007;49(8):839-848.
  • Pijls NH, Sels JW. Functional measurement of coronary stenosis. J Am Coll Cardiol. 2012;59(12):1045-1057.
  • Nogic J, Prosser H, O’Brien J, et al. The assessment of intermediate coronary lesions using intracoronary imaging. Cardiovasc Diagn Ther. 2020;10(5):1445-1460.
  • Koo BK, Hu X, Kang J, et al. Fractional flow reserve or intravascular ultrasonography to guide PCI. N Engl J Med. 2022;387(9):779-789.
  • Tonino PA, De Bruyne B, Pijls NH, et al. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med. 2009;360(3):213-224.
  • Lee JM, Kim HK, Park KH, et al. Fractional flow reserve versus angiography-guided strategy in acute myocardial infarction with multivessel disease: a randomized trial. Eur Heart J.  2023;44(6):473-484.
  • Hansson GK. Inflammation, atherosclerosis, and coronary artery disease. N Engl J Med. 2005;352(16):1685-1695.
  • Hilgendorf I, Swirski FK, Robbins CS. Monocyte fate in atherosclerosis. Arterioscler Thromb Vasc Biol. 2015;35(2):272-279. 
  • St-Pierre AC, Cantin B, Dagenais GR, et al. Low-density lipoprotein subfractions and the long-term risk of ischemic heart disease in men: 13-year follow-up data from the Québec Cardiovascular Study. Arterioscler Thromb Vasc Biol. 2005;25(3):553-559.
  • Mikhailidis DP, Elisaf M, Rizzo M, et al. “European panel on low density lipoprotein (LDL) subclasses”: a statement on the pathophysiology, atherogenicity and clinical significance of LDL subclasses. Curr Vasc Pharmacol. 2011;9(5):533-571.
  • Varbo A, Benn M, Tybjærg-Hansen A, Jørgensen AB, Frikke-Schmidt R, Nordestgaard BG. Remnant cholesterol as a causal risk factor for ischemic heart disease. J Am Coll Cardiol. 2013;61(4):427-436.
  • Hoogeveen RC, Gaubatz JW, Sun W, et al. Small dense low-density lipoprotein-cholesterol concentrations predict risk for coronary heart disease: the Atherosclerosis Risk In Communities (ARIC) study. Arterioscler Thromb Vasc Biol. 2014;34(5):1069-1077.
  • Langsted A, Freiberg JJ, Tybjaerg-Hansen A, Schnohr P, Jensen GB, Nordestgaard BG. Nonfasting cholesterol and triglycerides and association with risk of myocardial infarction and total mortality: the Copenhagen City Heart Study with 31 years of follow-up. J Intern Med. 2011;270(1):65-75.
  • Quispe R, Manalac RJ, Faridi KF, et al. Relationship of the triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio to the remainder of the lipid profile: The Very Large Database of Lipids-4 (VLDL-4) study. Atherosclerosis. 2015;242(1):243-250.
  • Triglyceride Coronary Disease Genetics Consortium and Emerging Risk Factors Collaboration, Sarwar N, Sandhu MS, et al. Triglyceride-mediated pathways and coronary disease: collaborative analysis of 101 studies. Lancet. 2010;375(9726):1634-1639.
  • Murphy AJ, Woollard KJ. High-density lipoprotein: a potent inhibitor of inflammation. Clin Exp Pharmacol Physiol. 2010; 37(7):710-718. 
  • Murphy AJ, Chin-Dusting JP, Sviridov D, Woollard KJ. The anti inflammatory effects of high density lipoproteins. Curr Med Chem. 2009;16(6):667-675.
  • Hessler JR, Robertson AL Jr, Chisolm III GM. LDL-induced cytotoxicity and its inhibition by HDL in human vascular smooth muscle and endothelial cells in culture. Atherosclerosis. 1979;32(3):213-229.
  • Li XP, Zhao SP, Zhang XY, Liu L, Gao M, Zhou QC. Protective effect of high density lipoprotein on endothelium-dependent vasodilatation. Int J Cardiol. 2000;73(3):231-236.
  • Kuvin JT, Rämet ME, Patel AR, Pandian NG, Mendelsohn ME, Karas RH. A novel mechanism for the beneficial vascular effects of high-density lipoprotein cholesterol: enhanced vasorelaxation and increased endothelial nitric oxide synthase expression. Am Heart J. 2002;144(1):165-172.
  • van de Woestijne AP, van der Graaf Y, Liem AH, et al. Low high-density lipoprotein cholesterol is not a risk factor for recurrent vascular events in patients with vascular disease on intensive lipid-lowering medication. J Am Coll Cardiol. 2013;62(20):1834-1841.
  • Che B, Zhong C, Zhang R, et al. Triglyceride-glucose index and triglyceride to high-density lipoprotein cholesterol ratio as potential cardiovascular disease risk factors: an analysis of UK biobank data. Cardiovasc Diabetol. 2023;22(1):34.
  • Dobiásová M, Frohlich J. The plasma parameter log (TG/HDL-C) as an atherogenic index: correlation with lipoprotein particle size and esterification rate in apoB-lipoprotein-depleted plasma (FER(HDL)). Clin Biochem. 2001;34(7):583-588.
  • Shao QY, Ma XT, Yang ZQ, et al. Prognostic significance of multiple triglycerides-derived metabolic indices in patients with acute coronary syndrome. J Geriatr Cardiol. 2022;19(6):456-468.
  • Su YM, Zhang R, Xu RF, et al. Triglyceride to high-density lipoprotein cholesterol ratio as a risk factor of repeat revascularization among patients with acute coronary syndrome after first-time percutaneous coronary intervention. J Thorac Dis. 2019;11(12):5087-5095.
  • Kundi H, Korkmaz A, Balun A, et al. Is in-stent restenosis after a successful coronary stent implantation due to stable angina associated with TG/HDL-C ratio? Angiology. 2017;68(9):816-822.
  • da Luz PL, Favarato D, Faria-Neto JR Jr, Lemos P, Chagas AC. High ratio of triglycerides to HDL-cholesterol predicts extensive coronary disease. Clinics (Sao Paulo). 2008;63(4):427-432.
  • Bampi AB, Rochitte CE, Favarato D, Lemos PA, da Luz PL. Comparison of non-invasive methods for the detection of coronary atherosclerosis. Clinics (Sao Paulo). 2009;64(7):675-682.
  • Ates AH, Canpolat U, Yorgun H, et al. Total white blood cell count is associated with the presence, severity and extent of coronary atherosclerosis detected by dual-source multislice computed tomographic coronary angiography. Cardiol J. 2011;18(4):371-377.
There are 40 citations in total.

Details

Primary Language English
Subjects Cardiology
Journal Section Research Articles [en] Araştırma Makaleleri [tr]
Authors

Can Özkan 0000-0001-6255-711X

Publication Date June 28, 2024
Submission Date April 17, 2024
Acceptance Date May 3, 2024
Published in Issue Year 2024 Volume: 5 Issue: 3

Cite

AMA Özkan C. The relationship between triglyceride/high-density lipoprotein cholesterol ratio and the functional significance of coronary lesions. J Med Palliat Care / JOMPAC / jompac. June 2024;5(3):149-154. doi:10.47582/jompac.1469728
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