Usefulness of the triglyceride to high-density lipoprotein cholesterol ratio for predicting mortality risk in type 2 diabetes: role of kidney dysfunction.
OBJECTIVE
An increased level of triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio has been identified as an independent predictor for cardiovascular events in the general population and in some groups of high-risk patients, such as type 2 diabetes. The aim of this study was to evaluate whether a high TG/HDL-C ratio is associated with an increased risk of all-cause and cardiovascular mortality in type 2 diabetic subjects, and whether this risk is modified by the presence of kidney dysfunction.


METHODS
We followed 3084 type 2 diabetic outpatients for a mean period of 4.9 years for the occurrence of mortality. The independent association between the TG/HDL-C ratio and all-cause and cardiovascular mortality was analyzed by Cox proportional hazard models and adjusted for several potential confounders, including kidney function measures.


RESULTS
During follow-up, 356 (12%) participants died, 46% of whom from cardiovascular causes. Higher TG/HDL-C ratio (third vs. first tertile) was associated with an increased hazard ratio of all-cause (hazard ratio 1.51, CI 95% 1.13-2.00, p=0.005) and cardiovascular (hazard ratio 1.70, 1.12-2.59, p=0.015) mortality after adjustment for traditional risk factors, body mass index, hemoglobin A1c and medication use. After additional adjustment for renal function measures (estimated glomerular filtration rate or albuminuria), the association between the TG/HDL-C ratio and the risk of mortality was abolished.


CONCLUSIONS
Our findings suggest that the predictive role of a high TG/HDL-C ratio in type 2 diabetes on cardiovascular and all-cause mortality might be largely mediated by the presence of kidney dysfunction.
Section of Endocrinology and Metabolism, Department of Medicine, University of Verona, Verona, Italy. giacomo.zoppini@univr.it
Giacomo
G
Zoppini
Giovanni
G
Targher
Carlo
C
Negri
Vincenzo
V
Stoico
Maria Luisa
ML
Gemma
Enzo
E
Bonora
D000368:Aged; D000419:Albuminuria / Q000401:mortality / Q000503:physiopathology; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood / Q000401:mortality* / Q000503:physiopathology; D016009:Chi-Square Distribution; D008076:Cholesterol, HDL / Q000097:blood*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000401:mortality* / Q000503:physiopathology; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007558:Italy / Q000453:epidemiology; D007668:Kidney / Q000503:physiopathology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014280:Triglycerides / Q000097:blood*
D015415:Biomarkers; D008076:Cholesterol, HDL; D014280:Triglycerides