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Significance of Non HDL-cholesterol and Triglyceride to HDL-cholesterol Ratio as Predictors for Metabolic Syndrome among Korean Elderly

한국 노인의 대사증후군 예측인자로서 혈중 Non HDL 콜레스테롤과 중성지방/HDL 콜레스테롤 비의 의의

  • Hong, Seung Bok (Department of Clinical Laboratory Science, Chungbuk Health & Science University) ;
  • Shin, Kyung-A (Department of Clinical Laboratory Science, Shinsung University)
  • 홍승복 (충북보건과학대학교 임상병리과) ;
  • 신경아 (신성대학교 임상병리과)
  • Received : 2018.08.29
  • Accepted : 2018.09.06
  • Published : 2018.09.30

Abstract

We evaluated the possible clinical application of Non HDL-cholesterol and triglyceride to HDL-cholesterol ratio as a metabolic syndrome predictor for the elderly in Korea. 1,543 elderly persons aged 65 years or older who visited the health examination center of Gyeonggi Regional General Hospital from January 2015 to December 2017 and had a health checkup were enrolled in this study. Metabolic syndrome was diagnosed based on the American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI) standards. Abdominal obesity was assessed by the Asia-Pacific standards presented at the World Health Organization (WHO) West Pacific Region. Non-HDL-cholesterol was calculated as the difference between total cholesterol and HDL-cholesterol. The metabolic syndrome predictive power was higher for triglyceride to HDL-cholesterol ratio than for Non HDL-cholesterol. After correcting for related factors, triglyceride to HDL-cholesterol ratio was higher in the $4^{th}$ quartile, which had a higher risk of developing metabolic syndrome, than in the $1^{st}$ quartile. The optimal cutoff value for the triglyceride to HDL-cholesterol ratio that predicts the onset of metabolic syndrome was 2.8. triglyceride to HDL-cholesterol ratio can be a simple and practical indicator of the risk of metabolic syndrome.

References

  1. Reaven GM. Role of insulin resistance in human disease (syndrome X): an expanded definition. Annu Rev Med. 1993; 44:121-131. https://doi.org/10.1146/annurev.me.44.020193.001005
  2. Park HS, Lee SY, Kim SM, Han JH, Kim DJ. Prevalence of the metabolic syndrome among Korean adults according to the criteria of the International Diabetes Federation. Diabetes Care. 2006;29:933-934. https://doi.org/10.2337/diacare.29.04.06.dc06-0069
  3. Lim JW, Kim SY, Ke SS, Cho BL. The prevalence of obesity, abdominal obesity and metabolic syndrome among elderly in general population. Korean J Fam Med. 2011;32:128-134. https://doi.org/10.4082/2011;32:128. https://doi.org/10.4082/kjfm.2011.32.2.128
  4. Guize L, Thomas F, Pannier B, Bean K, Danchin N, Benetos A. Metabolic syndrome: prevalence, risk factors and mortality in a French population of 62,000 subjects. Bull Acad Natl Med. 2006;190:685-697.
  5. Miccoli R, Bianchi C, Odoguardi L, Penno G, Caricato F, Giovannitti MG, et al. Prevalence of the metabolic syndrome among Italian adults according to ATP III definition. Nutr Metab Cardiovasc Dis. 2005;15:250-254. https://doi.org/10.1016/j.numecd.2004.09.002
  6. Kawamoto R, Oka Y, Tomita H, Kodama A. Non-HDL cholesterol as a predictor of carotid atherosclerosis in the elderly. J Atheroscler Thromb. 2005;12:143-148. https://doi.org/10.5551/jat.12.143
  7. Cui Y, Blumenthal RS, Flaws JA, Whiteman MK, Langenberg P, Bachorik PS, et al. Non-high-density lipoprotein cholesterol level as a predictor of cardiovascular disease mortality. Arch Intern Med. 2001;161:1413-1419. https://doi.org/10.1001/archinte.161.11.1413
  8. Lu W, Resnick HE, Jablonski KA, Jones KL, Jain AK, Howard WJ, et al. Non-HDL cholesterol as a predictor of cardiovascular disease in type 2 diabetes: the strong heart study. Diabetes Care. 2003;26:16-23. https://doi.org/10.2337/diacare.26.1.16
  9. Keys A, Karvonen MJ, Punsar S, Menotti A, Fidanza F, Farchi G. HDL serum cholesterol and 24-year mortality of men in Finland. Int J Epidemiol. 1984;13:428-435. https://doi.org/10.1093/ije/13.4.428
  10. Menotti A, Spagnolo A, Scanga M, Dima F. Multivariate prediction of coronary deaths in a 10 year follow-up of an Italian occupational male cohort. Acta Cardiol. 1992;47:311-320.
  11. Lee KH, Son JC, Kim BT, Choi BH, Hye JS, Cha CK, et al. Non-HDL Cholesterol as a risk factor of metabolic syndrome in Korean women. Korean J Obes. 2007;16:102-110.
  12. Salazar MR, Carbajal HA, Espeche WG, Leiva Sisnieguez CE, Balbin E, Dulbecco CA, et al. Relation among the plasma triglyceride/high-density lipoprotein cholesterol concentration ratio, insulin resistance, and associated cardio-metabolic risk factors in men and women. Am J Cardiol. 2012;109:1749-1753. https://doi.org/10.1016/j.amjcard.2012.02.016
  13. Salazar MR, Carbajal HA, Espeche WG, Aizpurua M, Leiva Sisnieguez CE, Leiva Sisnieguez BC, et al. Use of the plasma triglyceride/high-density lipoprotein cholesterol ratio to identify cardiovascular disease in hypertensive subjects. J Am Soc Hypertens. 2014;8:724-731. https://doi.org/10.1016/j.jash.2014.08.002
  14. Jeppesen J, Hein HO, Suadicani P, Gyntelberg F. High triglycerides/low high-density lipoprotein cholesterol, ischemic electrocardiogram changes, and risk of ischemic heart disease. Am Heart J. 2003;145:103-108. https://doi.org/10.1067/mhj.2003.45
  15. Burchfiel CM, Laws A, Benfante R, Goldberg RJ, Hwang LJ, Chiu D, et al. Combined effects of HDL cholesterol, triglyceride, and total cholesterol concentrations on 18-year risk of atherosclerotic disease. Circulation. 1995;92:1430-1436. https://doi.org/10.1161/01.CIR.92.6.1430
  16. Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation. 2005;112:2735-2752. https://doi.org/10.1161/CIRCULATIONAHA.105.169404
  17. World Health Organization. The Asia-Pacific Perspective: redefining obesity and its treatment. Sydney, Australia: Health communications Australia; 2000. p19-20.
  18. Lee SW, Kim HC, Lee HS, Suh I. Thirty-year trends in mortality from cerebrovascular diseases in Korea. Korean Circ J. 2016;46:507-514. https://doi.org/10.4070/kcj.2016.46.4.507
  19. Tsay YC, Chen CH, Pan WH. Ages at onset of 5 cardiometabolic diseases adjusting for nonsusceptibility: implications for the pathogenesis of metabolic syndrome. Am J Epidemiol. 2016;184:366-377. https://doi.org/10.1093/aje/kwv449
  20. Wilson PW, D'Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB. Prediction of coronary heart disease using risk factor categories. Circulation. 1998;97:1837-1847. https://doi.org/10.1161/01.CIR.97.18.1837
  21. Baigent C, Blackwell L, Emberson J, Holland LE, Reith C, Bhala N, et al. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet. 2010;376:1670-1681. https://doi.org/10.1016/S0140-6736(10)61350-5
  22. Preiss D, Neely D. Biochemistry laboratories should routinely report non-HDL-cholesterol. Ann Clin Biochem. 2015;52(Pt 6):629-631. https://doi.org/10.1177/0004563215594818
  23. Khan SH, Asif N, Ijaz A, Manzoor SM, Niazi NK, Fazal N. Status of non-HDL-cholesterol and LDL-cholesterol among subjects with and without metabolic syndrome. J Pak Med Assoc. 2018;68:554-558.
  24. Di Angelantonio E, Sarwar N, Perry P, Kaptoge S, Ray KK, Thompson A, et al. Major lipids, apolipoproteins, and risk of vascular disease. JAMA. 2009;302:1993-2000. https://doi.org/10.1001/jama.2009.1619
  25. Ginsberg HN, Zhang YL, Hernandez-Ono A. Regulation of plasma triglycerides in insulin resistance and diabetes. Arch Med Res. 2005;36:232-240. https://doi.org/10.1016/j.arcmed.2005.01.005
  26. Marotta T, Russo BF, Ferrara LA. Triglyceride-to-HDL-cholesterol ratio and metabolic syndrome as contributors to cardiovascular risk in overweight patients. Obesity (Silver Spring). 2010;18:1608-1613. https://doi.org/10.1038/oby.2009.446
  27. McLaughlin T, Reaven G, Abbasi F, Lamendola C, Saad M, Waters D, et al. Is there a simple way to identify insulin-resistant individuals at increased risk of cardiovascular disease? Am J Cardiol. 2005;96:399-404. https://doi.org/10.1016/j.amjcard.2005.03.085
  28. Kannel WB, Vasan RS, Keyes MJ, Sullivan LM, Robins SJ. Usefulness of the triglyceride-high-density lipoprotein versus the cholesterol-high-density lipoprotein ratio for predicting insulin resistance and cardiometabolic risk (from the Framingham Offspring Cohort). Am J Cardiol. 2008;101:497-501. https://doi.org/10.1016/j.amjcard.2007.09.109
  29. Kim-Dorner SJ, Deuster PA, Zeno SA, Remaley AT, Poth M. Should triglycerides and the triglycerides to high-density lipoprotein cholesterol ratio be used as surrogates for insulin resistance? Metabolism. 2010;59:299-304. https://doi.org/10.1016/j.metabol.2009.07.027
  30. Salazar MR, Carbajal HA, Espeche WG, Aizpurua M, Maciel PM, Reaven GM. Identification of cardiometabolic risk: visceral adiposity index versus triglyceride/HDL cholesterol ratio. Am J Med. 2014;127:152-157. https://doi.org/10.1016/j.amjmed.2013.10.012
  31. Song DK, Lee H, Sung YA, Oh JY. Triglycerides to high-density lipoprotein cholesterol ratio can predict impaired glucose tolerance in young women with polycystic ovary syndrome. Yonsei Med J. 2016;57:1404-1411. https://doi.org/10.3349/ymj.2016.57.6.1404
  32. Murguia-Romero M, Jimenez-Flores JR, Sigrist-Flores SC, Espinoza-Camacho MA, Jimenez-Morales M, Pina E, Mendez- Cruz AR, et al. Plasma triglyceride/HDL-cholesterol ratio, insulin resistance, and cardiometabolic risk in young adults. J Lipid Res. 2013;54:2795-2799. https://doi.org/10.1194/jlr.M040584
  33. Eckel RH, Yost TJ, Jensen DR. Alterations in lipoprotein lipase in insulin resistance. Int J Obes Relat Metab Disord. 1995;19(Suppl 1):S16-21.
  34. Grundy SM. Hypertriglyceridemia, atherogenic dyslipidemia, and the metabolic syndrome. Am J Cardiol. 1998;81:18-25.