Relationship between the cumulative exposure of triglyceride to high-density lipoprotein cholesterol ratio and the risk of atherosclerotic cardiovascular disease

Objective  To investigate the effect of cumulative exposure of triglyceride to high density lipoprotein cholesterol ratio (TG/HDL-C) on atherosclerotic cardiovascular disease (ASCVD).

Methods A prospective study was conducted. A total of 85 665 employees of Kailan Group who participated in physical examination for at least two times from 2006 or 2008 to 2012 were recruited and divided into four groups according to the quartile of cumulative TG/HDL-C: Group Q1 (＜2.59, n=21 416), Q2 (2.59–＜3.78, n=21 416), Q3 (3.78–＜5.86, n=21 417), Q4 (≥5.86, n=21 416). Kaplan-Meier method was used to calculate the cumulative incidence of ASCVD in different groups, and the Log-rank test was used to compare the cumulative incidence of ASCVD among groups. Multivariate Cox regression model was used to analyze the effects of cumulative TG/HDL-C on ASCVD.

Results During the median follow-up of 10.65 years, 8 411 (9.82%) of the subjects developed ASCVD and 6 901 (8.06%) died. After adjusting for confounding factors, Cox regression analysis showed that compared with group Q1, the risk of ASCVD in groups Q2, Q3 and Q4 increased by 14% (HR=1.14, 95%CI: 1.06–1.22, P＜0.001), 22% (HR=1.22, 95%CI: 1.15–1.31, P＜0.001) and 37% (HR=1.37, 95%CI: 1.29–1.47, P＜0.001), and the risk showed a gradually increasing trend (P＜0.001). Stratified analysis showed that in the population with high cumulative TG/HDL-C, the risk of ASCVD in the group of ＜60 years old, non-hypertensive and body mass index (BMI)＜24 kg/m² were higher than those in the group of ≥60 years old, hypertensive and BMI≥24 kg/m², respectively.

Conclusions  Cumulative TG/HDL-C is positively correlated with the risk of ASCVD. Long-term exposure to high TG/HDL-C may increase the risk of ASCVD. When the cumulative TG/HDL-C is at a high level, the risk of ASCVD in people aged ＜60 years is higher than that in people aged ≥60 years, and the risk in people without hypertension is higher than that in people with hypertension. Subjects with BMI＜24 kg/m² have a higher risk of ASCVD than those with BMI≥24 kg/m².