title: Comparison between European and Iranian cutoff points of triglyceride/high-density lipoprotein cholesterol concentrations in predicting cardiovascular disease outcomes.
abstract: BACKGROUND
  High triglyceride (TG) and low high-density lipoprotein cholesterol (HDL-C) are important cardiovascular risk factors. The exact prognostic value of the TG/HDL-C ratio, a marker for cardiovascular events, is currently unknown among Iranians so this study sought to determine the optimal cutoff point for the TG/HDL-C ratio in predicting cardiovascular disease events in the Iranian population.
  
  
  METHODS
  The Isfahan Cohort Study (ICS) is an ongoing, longitudinal, population-based study that was originally conducted on adults aged ≥ 35 years, living in urban and rural areas of three districts in central Iran. After 10 years of follow-up, 5431 participants were re-evaluated using a standard protocol similar to the one used for baseline. At both measurements, participants underwent medical interviews, physical examinations, and fasting blood measurements. "High-risk" subjects were defined by the discrimination power of indices, which were assessed using receiver operating characteristic (ROC) analysis; the optimal cutoff point value for each index was then derived.
  
  
  RESULTS
  The mean age of the participants was 50.7 ± 11.6 years. The TG/HDL-C ratio, at a threshold of 3.68, was used to screen for cardiovascular events among the study population. Subjects were divided into two groups ("low" and "high" risk) according to the TG/HDL-C concentration ratio at baseline. A slightly higher number of high-risk individuals were identified using the European cutoff points of 63.7% in comparison with the ICS cutoff points of 49.5%. The unadjusted hazard ratio (HR) was greatest in high-risk individuals identified by the ICS cutoff points (HR = 1.54, 95% CI [1.33-1.79]) vs European cutoff points (HR = 1.38, 95% [1.17-1.63]). There were no remarkable changes after adjusting for differences in sex and age (HR = 1.58, 95% CI [1.36-1.84] vs HR = 1.44, 95% CI [1.22-1.71]) for the ICS and European cutoff points, respectively.
  
  
  CONCLUSIONS
  The threshold of TG/HDL ≥ 3.68 is the optimal cutoff point for predicting cardiovascular events in Iranian individuals.
authors.affiliation: Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Mojgan
authors.initials: M
authors.lastname: Gharipour
authors.affiliation: Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran. Electronic address: sadeghimasoumeh@gmail.com.
authors.forename: Masoumeh
authors.initials: M
authors.lastname: Sadeghi
authors.affiliation: Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Minoo
authors.initials: M
authors.lastname: Dianatkhah
authors.affiliation: Cardiac Surgery Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Pouya
authors.initials: P
authors.lastname: Nezafati
authors.affiliation: Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Talaie
authors.affiliation: Neurology Department, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Shahram
authors.initials: S
authors.lastname: Oveisgharan
authors.affiliation: Associate Professor of Cardiology, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Jafar
authors.initials: J
authors.lastname: Golshahi
mesh_terms: D001774:Blood Chemical Analysis / Q000592:standards*; D002318:Cardiovascular Diseases / Q000097:blood* / Q000175:diagnosis* / Q000453:epidemiology; D008076:Cholesterol, HDL / Q000097:blood*; D015331:Cohort Studies; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D007492:Iran; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012372:ROC Curve; D012015:Reference Standards; D014280:Triglycerides / Q000097:blood*
chemical_list: D008076:Cholesterol, HDL; D014280:Triglycerides
keywords: Cardiovascular disease; Event; HDL-C; Ratio; Triglyceride