Impact of high triglyceride/high-density lipoprotein cholesterol ratio in non-st segment elevation myocardial infarction

Abstract

Introductıon: Globally, cardiovascular disease (CVD) is the leading cause of death. Among these risk factors, dyslipidemia, hypertension, and diabetes mellitus (DM) are significant pathological disorders that lead to this illness. In addition to being a risk factor for cardiovascular disease, insulin resistance is a prevalent characteristic of metabolic syndrome, obesity, and diabetes mellitus. It has been demonstrated that the triglyceride/HDL ratio is a valid indicator of insulin resistance. In this study, we tried to emphasize the criticality of early intervention in NSTEMI patients by revealing whether the TG/HDL ratio indicating insulin resistance is different between NSTEMI and ST elevation myocardial infarction (STEMI) patients. Methods: Patients admitted to a training and research hospital with a prediagnosis of acute coronary syndrome and diagnosed as having NSTEMI or STEMI were included in the study. Our study included 113 NSTEMI and 166 STEMI patients. Results: In NSTEMI patients, the mean HDL value was 39 (25-65) mg/dl, the mean LDL value was 105 (29-244) mg/dl, the mean T. cholesterol value was 180 (78-356) mg/dl, and the mean triglyceride value was 136 (37-360) mg/dl. When NSTEMI patients were compared with STEMI patients in terms of TG/HDL ratio, NSTEMI patients were significantly higher. (p:0.027; p<0.005). Conclusıon: Increased TG/HDL ratios are one measure of insulin resistance. The TG/HDL ratio is elevated in NSTEMI patients, according to our research. Therefore, we can help reduce morbidity and mortality by planning early intervention in NSTEMI patients with high TG/HDL ratios.

Keywords

• acute coronary syndrome
• Non-ST segment elevation myocardial infarction
• ST elevation myocardial infarction
• Triglyceride
• high density lipoprotein

References

1. 1.Dziedzic E. A., Gąsior J. S., Tuzimek A.,et al. (2022).Investigation of the associations of novelinflammatory biomarkers—Systemic InflammatoryIndex (SII) and Systemic Inflammatory ResponseIndex (SIRI)—With the severity of coronary arterydisease and acute coronary syndrome occurrence.International Journal of Molecular Sciences, 23(17),9553.
2. 2.Zhou M, Liu J, Hao Y, et al. Prevalence and in-hospital outcomes of diabetes among patients withacute coronary syndrome in China: fndings from theImproving Care for Cardiovascular Disease in China-Acute Coronary Syndrome Project. CardiovascDiabetol. 2018;17(1):147.
3. 3.Ray KK, Colhoun HM, Szarek M, et al. Efects ofalirocumab on cardiovascular and metabolicoutcomes after acute coronary syndrome in patients with or without diabetes: a prespecifed analysis of the ODYSSEY OUTCOMES randomised controlled trial. Lancet Diabetes Endocrinol. 2019;7(8):618–28.
4. 4.Preis SR, Hwang S-J, Coady S, et al. Trends in all-cause and cardiovascular disease mortality amongwomen and men with and without diabetes mellitusin the Framingham Heart Study, 1950 to 2005.Circulation. 2009;119(13):1728–35,
5. 5.McGuire DK, Emanuelsson H, Granger CB, et al.Influence of diabetes mellitus on clinical outcomesacross the spectrum of acute coronary syndromes.Findings from the GUSTO-IIb study. GUSTO IIbInvestigators. Eur Heart J 2000;21:1750–8.
6. 6.Hill MA, Yang Y, Zhang L, et al. Insulin resistance,cardiovascular stifening and cardiovascular disease.Metabolism. 2021;119: 154766
7. 7.Ormazabal V, Nair S, Elfeky O, et al. Associationbetween insulin resistance and the development ofcardiovascular disease. Cardiovasc Diabetol.2018;17(1):122.
8. 8.Vera Bittner B, Johnson D, Zineh I, et al. TheTG/HDL cholesterol ratio predicts all causemortality in women with suspected myocardialischemia: a report from the women’s ischemiasyndrome evaluation (WISE). Am Heart J2009;157:548–55: Van Linthout S, Spillmann F,Schultheiss HP, et al. High-density lipoprotein at theinterface of type 2 diabetes mellitus andcardiovascular disorders. Curr Pharm Des2010;16:1504–16.

9. 9.Li C, Ford ES, Meng YX, Reaven GM. Does theassociation of the triglyceride to high-densitylipoprotein cholesterol ratio with fasting seruminsulin differ by race/ethnicity? CardiovascDiabetol. 2008; 7:4, doi: 10.1186/1475-2840-7-4.
10. 10.Global, regional, and national age-sex-specificmortality for 282 causes of death in 195 countriesand territories, 1980-2017: a systematic analysis forthe Global Burden of Disease Study 2017. Lancet2018; 392: 1736-88.
11. 11.Benjamin EJ, Blaha MJ, Chiuve SE, et al. HeartDisease and Stroke Statistics-2017 Update: A Report From the American Heart Association. Circulation2017; 135: e146-e603.
12. 12.McManus DD, Gore J, Yarzebski J, et al. Recenttrends in the incidence, treatment, and outcomes ofpatients with STEMI and NSTEMI. Am J Med 2011;124: 40-7.
13. 13.GRACE Investigators. Rationale and design of theGRACE (Global Registry of Acute Coronary Events)project: a multinational registry of patientshospitalized with acute coronary syndromes. AmHeart J 2001;141: 190–9.
14. 14.Bata IR, Gregor RD, Eastwood BJ, Wolf HK.Trends in the incidence of acute myocardialinfarction between 1984 and 1993—The HalifaxCounty MONICA Project. Can J Cardiol 2000;16:589–95.
15. 15.Fodor G. Primary prevention of CVD: treatingdyslipidaemia. BMJ Clin Evid 2008;6:2008: SampsonUK, Fazio S, Linton MF. Residual cardiovascular riskdespite optimal LDL-cholesterol reduction withstatins: the evidence, etiology, and therapeuticchallenges. Curr Atheroscler Rep 2012;14:1–0.
16. 16.Toprak K., Kaplangoray M., Akyol S., et al. (2024). The non-HDL-C/HDL-C ratio is a strong andindependent predictor of the no-reflowphenomenon in patients with ST-elevationmyocardial infarction. Acta Cardiologica, 79(2), 194-205.
17. 17.Lauber C, Gerl MJ, Klose C, et al. Lipidomic riskscores are independent of polygenic risk scores andcan predict incidence of diabetes and cardiovascular disease in a large population cohort. PLoS Biol.2022;20(3): e3001561.https://doi.org/10.1371/journal. pbio.3001561:Zhang M, Zhang J, Chua HZ, Feng R, Lu M, Tian Y. Core outcome set for stable angina pectoris in traditionalChinese medicine (COS-SAP-TCM). AcupunctureHerbal Med. 2021;1(1):39–48.https://doi.org/10.1097/HM9.0000000000000007.
18. 18.Guérin M, Le Goff W, Lassel TS, et al. Atherogenicrole of elevated CE transfer from HDL to VLDL(1)and dense LDL in type 2 diabetes: impact of thedegree of triglyceridemia. Arterioscler Thromb VascBiol 2001;21:282–8.
19. 19.Kaplangoray M., Toprak K., Başanalan F., et al.(2023). Investigation of the relationship betweentriglycerides-glucose index and coronary slow flow: A retrospective case-control study. Arquivos Brasileiros de Cardiologia, 120, e20220679.
20. 20.Do R., Willer C. J., Schmidt E. M., et al. (2013).Common variants associated with plasmatriglycerides and risk for coronary artery disease.Nature genetics, 45(11), 1345-52.
21. 21.Fogelstrand P, Boren J. Retention of atherogeniclipoproteins in the artery wall and its role inatherogenesis. Nutr Metab Cardiovasc Dis.2012;22:1–7.
22. 22.Peng J., Luo F., Ruan G., Peng R., & Li X. (2017).Hypertriglyceridemia and atherosclerosis. Lipids inhealth and disease, 16, 1-12.
23. 23.Puri R., Nissen S. E., Shao M., et al (2016). Non-HDL cholesterol and triglycerides: implications forcoronary atheroma progression and clinical events.Arteriosclerosis, thrombosis, and vascular biology,36(11), 2220-8.
24. 24.Yun JS, Ko SH. Current trends in epidemiology ofcardiovascular disease and cardiovascular riskmanagement in type 2 diabetes. Metabolism2021;123: 154838.
25. 25.Volmink JA, Newton JN, Hicks NR, et al. Coronaryevent and case fatality rates in an Englishpopulation: results of the Oxford myocardialinfarction incidence study. The Oxford MyocardialInfarction Incidence Study Group. Heart1998;80:40–4.
26. 26.Bahit MC, Granger CB, Wallentin L. Persistence ofthe prothrombotic state after acute coronarysyndromes: implications for treatment. Am Heart J2002;143:205–216: Bogaty P, Poirier P, Simard S, etal. Biological profiles in subjects with recurrentacute coronary events compared with subjects withlong-standing stable angina. Circulation 2001;103:3062–8.
27. 27.McGuire DK, Emanuelsson H, Granger CB, et al.Influence of diabetes mellitus on clinical outcomesacross the spectrum of acute coronary syndromes.Findings from the GUSTO-IIb study. GUSTO IIbInvestigators. Eur Heart J 2000;21:1750–8.
28. 28.Malmberg K, Ryden L, Wedel H, Birkeland K,Bootsma A, Dickstein K, Efendic S, Fisher M,Hamsten A, Herlitz J, Hildebrandt P, MacLeod K,Laakso M, Torp-Pedersen C, Waldenstrom A. Intense metabolic control by means of insulin in patientswith diabetes mellitus and acute myocardialinfarction (DIGAMI 2): effects on mortality andmorbidity. Eur Heart J 2005;26:650–61.
29. 29.Toprak K., Atherogenic index of plasma is anindependent risk factor for contrast inducednephropathy in patients with non-ST elevationmyocardial infarction. Angiology,2023, 74(5), 427-34.
30. 30.Bilgin S., Aktas G., Atak T. B. M., et al. (2022).Triglyceride to high density lipoprotein cholesterolratio is elevated in patients with complicated type 2diabetes mellitus. Acta facultatis medicaeNaissensis, 39(1), 66-73.
31. 31.Nicholls SJ, Tuzcu EM, Wolski K, et al. Loweringthe triglyceride/ high-density lipoproteincholesterol ratio is associated with the beneficialimpact of pioglitazone on progression of coronaryatherosclerosis in diabetic patients: insights fromthe PERISCOPE (Pioglitazone Effect on Regression of Intravascular Sonographic Coronary ObstructionProspective Evaluation) study. J Am Coll Cardiol2011;57:153–9.
32. 32.Bartnik M, Ryden L, Ferrari R, et al. Theprevalence of abnormal glucose regulation inpatients with coronary artery disease acrossEurope. The Euro Heart Survey on diabetes and theheart. Eur Heart J 2004;25:1880–1890.