The role of plasma triglyceride/high-density lipoprotein cholesterol ratio to predict cardiovascular outcomes in chronic kidney disease

Research

Alper Sonmez¹, Mahmut Ilker Yilmaz², Mutlu Saglam³, Hilmi Umut Unal², Mahmut Gok², Hakki Cetinkaya², Murat Karaman², Cem Haymana^1*, Tayfun Eyileten², Yusuf Oguz², Abdulgaffar Vural², Manfredi Rizzo⁴ and Peter P Toth⁵

• *
  Corresponding author: Cem Haymana [email protected]

Author Affiliations

¹ Department of Endocrinology and Metabolism, Gulhane School of Medicine, Etlik, 06018, Ankara, Turkey

² Department of Nephrology, Gulhane School of Medicine, Etlik, 06018, Ankara, Turkey

³ Department of Radiology, Gulhane School of Medicine, Etlik, 06018, Ankara, Turkey

⁴ Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy

⁵ University of Illinois School of Medicine, Peoria, Il, USA

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Lipids in Health and Disease 2015, 14:29 
doi:10.1186/s12944-015-0031-4

Published: 16 April 2015

Abstract (provisional)

Background Cardiovascular disease (CVD) risk is substantially increased in subjects
with chronic kidney disease (CKD). The Triglycerides (TG) to High-Density Lipoprotein
Cholesterol (HDL-C) ratio is an indirect measure of insulin resistance and an independent
predictor of cardiovascular risk. No study to date has been performed to evaluate
whether the TG/ HDL-C ratio predicts CVD risk in patients with CKD. Methods A total
of 197 patients (age 53?±?12 years) with CKD Stages 1 to 5, were enrolled in this
longitudinal, observational, retrospective study. TG/ HDL-C ratio, HOMA-IR indexes,
serum asymmetric dimethyl arginine (ADMA), high sensitivity C-reactive protein (CRP),
parathyroid hormone (PTH), calcium, phosphorous, estimated glomerular filtration rate
(eGFR), and albumin levels were measured. Flow mediated vasodilatation (FMD) of the
brachial artery was assessed by using high-resolution ultrasonography. Results A total
of 11 cardiovascular (CV) deaths and 43 nonfatal CV events were registered in a mean
follow-up period of 30 (range 9 to 35) months. Subjects with TG/HDL-C ratios above
the median values (gt;3.29) had significantly higher plasma ADMA, PTH, and phosphorous
levels (p?=?0.04, p?=?0.02, p?=?0.01 respectively) and lower eGFR and FMD values (p?=?0.03,
p?lt;?0.001 respectively). The TG/ HDL-C ratio was an independent determinant of
FMD (??=??0.25 p?=?0.02) along with TG, HDL-C, hsCRP, serum albumin, phosphate levels,
systolic blood pressure, PTH, eGFR and the presence of diabetes mellitus. The TG/HDL-C
ratio was also a significant independent determinant of cardiovascular outcomes [HR:
1.36 (1.11-1.67) (p?=?0.003)] along with plasma ADMA levels [HR: 1.31 (1.13-1.52)
(p?lt;?0.001)] and a history of diabetes mellitus [HR: 4.82 (2.80-8.37) (p?lt;?0.001)].
Conclusion This study demonstrates that the elevated TG/ HDL-C ratio predicts poor
CVD outcome in subjects with CKD. Being a simple, inexpensive, and reproducible marker
of CVD risk, the TG/ HDL-C ratio may emerge as a novel and reliable indicator among
the many well-established markers of CVD risk in CKD. Systematic review registration
Clinical trial registration number and date: NCT02113462 / 10-04-2014.