Yokoyama Katsuaki, Tani Shigemasa, Matsuo Rei, Matsumoto Naoya
Department of Cardiology, Nihon University Hospital, Tokyo, Japan.
Department of Health Planning Center, Nihon University Hospital, 1-6 Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-8309, Japan.
Heart Vessels. 2019 Feb;34(2):227-236. doi: 10.1007/s00380-018-1247-9. Epub 2018 Aug 23.
Hypertriglyceridemia, which often leads to both low-density lipoprotein (LDL) and high-density lipoprotein (HDL) metabolic disorders, is a strong risk factor for the development of atherosclerotic cardiovascular disease (ASCVD). We hypothesized that the triglyceride (TG)/HDL cholesterol (TG/HDL-C) ratio may be more useful for estimation of the LDL-particle size, as a well-known risk factor for ASCVD, as compared to the serum TG level per se. Polyacrylamide gel electrophoresis was used in this study to estimate the LDL-particle size [relative LDL migration (LDL-Rm value)] in 649 consecutive patients with one additional risk factor for ASCVD. Multivariable regression analysis identified both serum TG (β = 0.556, p < 0.0001) and the serum TG/HDL-C ratio (β = 0.607, p < 0.0001) as independent indicators of the LDL-particle size. In terms of evaluation of the accuracy of indicators of LDL-Rm values equal to or greater than 0.40, which are suggestive of the presence of large amounts of small-dense LDL and represent the upper limit (mean + 2 standard deviation) of the normal range in this population, both the serum TG level and serum TG/HDL-C ratio showed high accurate areas under the receiver-operating characteristic curve (0.900 vs. 0.914), but with a negative likelihood ratio of 0.506 vs. 0.039, indicating that the TG/HDL-C ratio model is superior for excluding patients with values below the cutoff value and with LDL-Rm values ≥ 0.40. Furthermore, in 456 patients followed up for at least 1 year, multivariable regression analysis identified increased serum TG/HDL-C ratio as an independent predictor of a decreased LDL-particle size. These results suggest that the serum TG/HDL-C ratio may be more useful for assessing the risk of ASCVD as compared to the serum TG level per se. To reduce the risk of ASCVD, it may be important to focus not only on changes of the serum LDL-C, but also on those of the serum TG/HDL-C ratio.
高甘油三酯血症常导致低密度脂蛋白（LDL）和高密度脂蛋白（HDL）代谢紊乱，是动脉粥样硬化性心血管疾病（ASCVD）发生的重要危险因素。我们推测，与血清甘油三酯（TG）水平本身相比，甘油三酯（TG）/高密度脂蛋白胆固醇（TG/HDL-C）比值可能更有助于评估LDL颗粒大小，而LDL颗粒大小是ASCVD的一个众所周知的危险因素。本研究采用聚丙烯酰胺凝胶电泳法对649例具有一项ASCVD额外危险因素的连续患者进行LDL颗粒大小评估[相对LDL迁移率（LDL-Rm值）]。多变量回归分析确定血清TG（β = 0.556，p < 0.0001）和血清TG/HDL-C比值（β = 0.607，p < 0.0001）均为LDL颗粒大小的独立指标。在评估LDL-Rm值等于或大于0.40的指标准确性时，该指标提示存在大量小而密LDL，且代表该人群正常范围的上限（均值 + 2标准差），血清TG水平和血清TG/HDL-C比值在受试者工作特征曲线下均显示出较高的准确面积（分别为0.900和0.914），但阴性似然比分别为0.506和0.039，这表明TG/HDL-C比值模型在排除低于临界值且LDL-Rm值≥ 0.40的患者方面更具优势。此外，在456例至少随访1年的患者中，多变量回归分析确定血清TG/HDL-C比值升高是LDL颗粒大小减小的独立预测因素。这些结果表明，与血清TG水平本身相比，血清TG/HDL-C比值可能更有助于评估ASCVD风险。为降低ASCVD风险，不仅关注血清LDL-C的变化，还关注血清TG/HDL-C比值的变化可能很重要。
