title: The role of plasma triglyceride/high-density lipoprotein cholesterol ratio to predict cardiovascular outcomes in chronic kidney disease.
abstract: BACKGROUND
  Cardiovascular disease (CVD) risk is substantially increased in subjects with chronic kidney disease (CKD). The Triglycerides (TG) to High-Density Lipoprotein Cholesterol (HDL-C) ratio is an indirect measure of insulin resistance and an independent predictor of cardiovascular risk. No study to date has been performed to evaluate whether the TG/HDL-C ratio predicts CVD risk in patients with CKD.
  
  
  METHODS
  A total of 197 patients (age 53±12 years) with CKD Stages 1 to 5, were enrolled in this longitudinal, observational, retrospective study. TG/HDL-C ratio, HOMA-IR indexes, serum asymmetric dimethyl arginine (ADMA), high sensitivity C-reactive protein (CRP), parathyroid hormone (PTH), calcium, phosphorous, estimated glomerular filtration rate (eGFR), and albumin levels were measured. Flow mediated vasodilatation (FMD) of the brachial artery was assessed by using high-resolution ultrasonography.
  
  
  RESULTS
  A total of 11 cardiovascular (CV) deaths and 43 nonfatal CV events were registered in a mean follow-up period of 30 (range 9 to 35) months. Subjects with TG/HDL-C ratios above the median values (>3.29) had significantly higher plasma ADMA, PTH, and phosphorous levels (p=0.04, p=0.02, p=0.01 respectively) and lower eGFR and FMD values (p=0.03, p<0.001 respectively). The TG/HDL-C ratio was an independent determinant of FMD (β=-0.25 p=0.02) along with TG, HDL-C, hsCRP, serum albumin, phosphate levels, systolic blood pressure, PTH, eGFR and the presence of diabetes mellitus. The TG/HDL-C ratio was also a significant independent determinant of cardiovascular outcomes [HR: 1.36 (1.11-1.67) (p=0.003)] along with plasma ADMA levels [HR: 1.31 (1.13-1.52) (p<0.001)] and a history of diabetes mellitus [HR: 4.82 (2.80-8.37) (p<0.001)].
  
  
  CONCLUSIONS
  This study demonstrates that the elevated TG/HDL-C ratio predicts poor CVD outcome in subjects with CKD. Being a simple, inexpensive, and reproducible marker of CVD risk, the TG/HDL-C ratio may emerge as a novel and reliable indicator among the many well-established markers of CVD risk in CKD.
  
  
  BACKGROUND
  Clinical trial registration number and date: NCT02113462 / 10-04-2014.
authors.affiliation: Department of Endocrinology and Metabolism, Gulhane School of Medicine, 06018, Etlik, Ankara, Turkey. alpersonmez@yahoo.com.
authors.forename: Alper
authors.initials: A
authors.lastname: Sonmez
authors.affiliation: Department of Nephrology, Gulhane School of Medicine, 06018, Etlik, Ankara, Turkey. mahmutiyilmaz@yahoo.com.
authors.forename: Mahmut Ilker
authors.initials: MI
authors.lastname: Yilmaz
authors.affiliation: Department of Radiology, Gulhane School of Medicine, 06018, Etlik, Ankara, Turkey. mdsaglam@yahoo.com.
authors.forename: Mutlu
authors.initials: M
authors.lastname: Saglam
authors.affiliation: Department of Nephrology, Gulhane School of Medicine, 06018, Etlik, Ankara, Turkey. hilmiumut@hotmail.com.
authors.forename: Hilmi Umut
authors.initials: HU
authors.lastname: Unal
authors.affiliation: Department of Nephrology, Gulhane School of Medicine, 06018, Etlik, Ankara, Turkey. mahmut_gok@yahoo.com.tr.
authors.forename: Mahmut
authors.initials: M
authors.lastname: Gok
authors.affiliation: Department of Nephrology, Gulhane School of Medicine, 06018, Etlik, Ankara, Turkey. drhakkicetinkaya@yahoo.com.
authors.forename: Hakki
authors.initials: H
authors.lastname: Cetinkaya
authors.affiliation: Department of Nephrology, Gulhane School of Medicine, 06018, Etlik, Ankara, Turkey. drmuratkaraman@gmail.com.
authors.forename: Murat
authors.initials: M
authors.lastname: Karaman
authors.affiliation: Department of Endocrinology and Metabolism, Gulhane School of Medicine, 06018, Etlik, Ankara, Turkey. cemhaymana@hotmail.com.
authors.forename: Cem
authors.initials: C
authors.lastname: Haymana
authors.affiliation: Department of Nephrology, Gulhane School of Medicine, 06018, Etlik, Ankara, Turkey. teyileten@gmail.com.
authors.forename: Tayfun
authors.initials: T
authors.lastname: Eyileten
authors.affiliation: Department of Nephrology, Gulhane School of Medicine, 06018, Etlik, Ankara, Turkey. heceperen@yahoo.com.
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Oguz
authors.affiliation: Department of Nephrology, Gulhane School of Medicine, 06018, Etlik, Ankara, Turkey. agvural@gata.edu.tr.
authors.forename: Abdulgaffar
authors.initials: A
authors.lastname: Vural
authors.affiliation: Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy. manfredi.rizzo@unipa.it.
authors.forename: Manfredi
authors.initials: M
authors.lastname: Rizzo
authors.affiliation: University of Illinois School of Medicine, Peoria, Il, USA. Peter.Toth@cghmc.com.
authors.forename: Peter P
authors.initials: PP
authors.lastname: Toth
mesh_terms: D000328:Adult; D000368:Aged; D001120:Arginine / Q000031:analogs & derivatives / Q000097:blood; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D002318:Cardiovascular Diseases / Q000097:blood* / Q000209:etiology; D008076:Cholesterol, HDL / Q000097:blood*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D051436:Renal Insufficiency, Chronic / Q000097:blood* / Q000150:complications; D012189:Retrospective Studies; D012709:Serum Albumin / Q000032:analysis; D014280:Triglycerides / Q000097:blood*
chemical_list: D015415:Biomarkers; D008076:Cholesterol, HDL; D010281:Parathyroid Hormone; D012709:Serum Albumin; D014280:Triglycerides; C018524:N,N-dimethylarginine; D002097:C-Reactive Protein; D001120:Arginine