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

Year 2024, , 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

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

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.