The triglyceride HDL cholesterol ratio: an independent predictor of obstructive coronary artery disease and myocardial ischemia in patients with chronic coronary syndrome

1671 Background: The triglycerides to high-density lipoprotein cholesterol (TG/HDL) ratio is a marker of metabolic syndrome. Its relationship with the presence of significant coronary artery disease or ischemia has never been investigated. Methods: The TG/HDL ratio was evaluated in consecutive patients with known or suspected CAD undergoing stress-rest myocardial perfusion scintigraphy (MPS) and coronary angiography. Results: The study population included 1,097 patients (75% men; median age 72 years; 26% with previous CAD, 39% with diabetes). Moderate/severe perfusion abnormalities during stress (summed stress score >7) were documented in 60% of patients, obstructive CAD (>70% stenosis in at least one major coronary vessel) in 74%; 36% underwent early revascularization. The median baseline TG/HDL ratio was 8.9 (interquartile interval 8.6-9.2). Specifically, patients with obstructive CAD had more often hypercholesterolemia, higher total and low-density lipoprotein (LDL) cholesterol and TGs, and a higher TG/HDL ratio (2.5 [1.8-3.1] vs. 2.0 [1.7-2.5], p 7 or obstructive CAD plus SSS >7 displayed the same differences in their lipid profile. The TG/HDL ratio predicted obstructive CAD, SSS >7 and their combination over age, gender, family history of CAD, previous MI and/or coronary revascularization, current smoking status, hypertension, obesity, stage 3-5 chronic kidney disease, diabetes, LDL and HDL cholesterol, hs-CRP, and LVEF. The ≥2.33 TG/HDL cut-off (IV quartile) yielded independent prognostic significance for obstructive CAD and/or SSS >7 in the same model, and reclassified patient risk (Figure). Conclusions: Absolute TG/HDL ratio values and the 2.33 cut-off yield strong independent prognostic significance for obstructive CAD and/or moderate-to-severe ischemia (SSS >7).