Triglyceride to HDL-Cholesterol Ratio as a Predictor of Ischemic Stroke in Hypertensive Patients: A Case-Controlled Study
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ABSTRACT
Background: Stroke is preventable through risk factor control. One significant risk factor is high cholesterol, which is currently managed by controlling low-density lipoprotein cholesterol (LDL-C) levels. Recent studies have increasingly focused on factors contributing to atherosclerosis. Research has explored the association of the Triglyceride to high-density lipoprotein cholesterol (HDL-C) ratio with cardiovascular disease, finding that individuals with high Triglyceride levels and low HDL levels have an increased risk of developing cardiovascular disease.
Methods: This retrospective case-control study analyzed hypertensive patients treated at the Primary Care Unit of Chiangrai Prachanukroh Hospital between January 1, 2023, and December 31, 2023. Inclusion criteria comprised patients diagnosed with hypertension. Exclusion criteria were patients with a history of coronary artery disease or ischemic stroke before January 1, 2023, and those diagnosed with cardioembolic stroke. From a total pool of 5,808 individuals, 1,000 controls were selected via systematic random sampling, and 58 cases were identified. Data for the control group were derived from annual blood test results over the preceding three years, while data for the case group were taken from blood tests recorded on the date of stroke diagnosis. Statistical analysis was performed using logistic regression to compare stroke and non-stroke groups.
Results: Among the study population, 58 patients (5.8% of the sampled group) were diagnosed with ischemic stroke. When the Triglyceride-HDL ratio of the control group was divided into quartiles, patients in the highest quartile (Q4: 3.35–5.13) showed an adjusted odd ratio (OR) of 7.17 (95% CI: 2.34–21.94, p < 0.001) compared to those in the lowest quartile (Q1: 0–1.40).
Conclusions: A Triglyceride-HDL ratio exceeding 3.35 is significantly associated with an increased likelihood of ischemic stroke. This ratio may serve as a supplementary factor, alongside other traditional risk factors, to identify high-risk hypertensive patients who require intensive risk management to prevent future strokes. However, further prospective studies are recommended to track patients with high ratios over time to establish a definitive causal relationship.
Keywords: triglyceride-HDL ratio, ischemic stroke, cardiovascular disease
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References
EClinicalMedicine. The rising global burden of stroke [Editorial]. EClinicalMedicine. 2023;59:102028. doi: 10.1016/j.eclinm.2023.102028. PMID: 37256100.
สมศักดิ์ เทียมเก่า. อุบัติการณ์โรคหลอดเลือดสมองประเทศ ไทย. วารสารประสาทวิทยาแห่งประเทศไทย. 2565;39:39-46.
รุ่งโรจน์ กฤตยพงษ์, สุรพันธ์ สิทธิสุข, สุรจิต สุนทรธรรม, วรรณี นิธิยานันท์, วีรพันธุ์ โขวิฑูรกิจ, ประวีณ โล่ห์เลขา, และคณะ. แนวทางเวชปฏิบัติการใช้ยารักษาภาวะไขมันผิดปกติเพื่อป้องกันโรคหัวใจและหลอดเลือด พ.ศ. 2567. กรุงเทพฯ: สำนักพิมพ์กรุงเทพเวชสาร; 2567.
American Heart Association/American College of Cardiology. 2018 Guideline on the Management of Blood Cholesterol. J Am Coll Cardiol. 2019;73:e285-e350.
Mach F, Baigent C, Catapano AL, Koskinas KC, Casula M, Badimon L et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias. Eur Heart J. 2020;41:111-88.
Ding PF, Zhang HS, Wang J, Gao YY, Mao JN, Hang CH, et al. Insulin resistance in ischemic stroke: Mechanisms and therapeutic approaches. Front Endocrinol (Lausanne). 2022;13:1092431. PubMed PMID: 36589857
Simonson DC. Insulin resistance and diabetes in chronic renal disease. In: Wilcox CS, editor. Textbook of nephro-endocrinology. United States of America: Academic Press; 2009. p. 383-409.
Lee JS, Chang Y, Kim Y, Yun KE, Cho J, Guallar E, et al. Triglyceride and HDL-C dyslipidemia and risks of coronary heart disease and ischemic stroke by glycemic dysregulation status: The Strong Heart Study. Diabetes Care. 2017;40:529-37.
Sullivan KM, Dean A, Soe MM. OpenEpi: Open Source Epidemiologic Statistics for Public Health, Version 3. Sample Size for Match/Unmatched Case-Control Studies [Internet]. 2013 [cited 2024 Aug 2]. Available from: https://www.openepi.com/SampleSize/SSCC.htm
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. 2008;63:427-32.
Salazar MR, Espeche WG, Balbín E, Garcia Aurrecoechea S, Marillet AG, Leiva Sisnieguez CE, et al. Use of the plasma triglyceride/HDL ratio to identify cardiovascular disease in hypertensive subjects. J Am Soc Hypertens. 2014;8:724-31.
Che B, Zhong C, Zhang Y, Zhou X, Wang A, Zhao X, et al. Triglyceride-glucose index and TG/HDL ratio as potential CVD risk factors. Cardiovasc Diabetol. 2023;22:34-40.
World Health Organization. The Asia-Pacific perspective: redefining obesity and its treatment. Sydney: Health Communications Australia; 2000.
International Diabetes Federation. The IDF consensus worldwide definition of the metabolic syndrome [Internet]. 2006 [cited 2024 May 20]. Available from: https://www.idf.org/
Thai Hypertension Society. 2019 Thai Guidelines on the Treatment of Hypertension. Bangkok: Trick Series; 2019.
Thai Medical Services Department. Clinical Practice Guideline for Diabetes 2023. Bangkok: Sri-Muang Printing; 2023.
Thai Atherosclerosis Society. Clinical Practice Guidelines on Pharmacologic Therapy of Dyslipidemia for Cardiovascular Disease Prevention 2016. Bangkok: Thai Atherosclerosis Society; 2016.
Park B, Jung D, Lee HS, Lee YJ. Triglyceride to HDL-cholesterol ratio and the incident risk of ischemic heart disease among Koreans without diabetes: a longitudinal study using national health insurance data. Front Cardiovasc Med. 2021;8:716698. PubMed PMID: 34490378
Sato F, Nakamura Y, Kayaba K, Ishikawa S. TG/HDL-C ratio as a predictor of stroke in the population with healthy BMI. Nutr Metab Cardiovasc Dis 2022;32:1872-9.
Zhang S, Cao C, Han Y, Hu H, Zheng X. A nonlinear relationship between the triglycerides to high-density lipoprotein cholesterol ratio and stroke risk. Diabetol Metab Syndr. 2024;16:96-108.
