High triglyceride to HDL cholesterol ratio is associated with increased coronary heart disease among White but not Black adults

Triglyceride to High-Density Lipoprotein Cholesterol Ratio as a Marker of Subclinical Coronary Atherosclerosis and Hepatic Steatosis in Familial Hypercholesterolemia

OBJECTIVE

Features of the cardiometabolic syndrome are prevalent in patients with familial hypercholesterolemia (FH). Triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio, a surrogate marker of insulin resistance, may be a robust predictor of cardiac events in the general population. We explored the association between TG/HDL-C ratio and high-risk coronary artery plaque (HRP) and hepatic steatosis (HS) in asymptomatic patients with FH.

METHODS

We conducted a cross-sectional study of 290 patients (mean age = 49 years, 44% male) who underwent computed tomography coronary angiography for cardiovascular risk assessment. HRP and HS were assessed from computed tomography coronary angiography, and TG/HDL-C ratio was derived from the fasting lipid panel collected around time of scanning. Associations were assessed using binary logistic and Kaplan-Meier analysis.

RESULTS

TG/HDL-C ratio was significantly associated with HRP (odds ratio, 1.27; 95% CI, 1.04-1.56; P = .020) and HS (odds ratio, 1.71; 95% CI, 1.17-2.51; P = .005) after adjusting for age, body mass index, smoking, and coronary calcium score. TG/HDL-C ratio was associated with HRP in patients treated with lipid-lowering medications (P = .042) and inclusion in a predictive model outperformed the FH-Risk-Score (area under receiver operating characteristic 0.74 vs 0.63; P = .004). An elevated TG/HDL-C ratio predicted myocardial infarction or coronary revascularization over a median follow-up of 91 months with 10 cardiac events recorded (P = .043). TG/HDL-C ratio was strongly positively correlated (P < .001 for all) with markers of cardiometabolic dysfunction: lipid accumulation product (r = 0.81), visceral adiposity index (r = 0.96), and triglyceride-glucose index (r = 0.91).

CONCLUSION

TG/HDL-C ratio was strongly associated with HRP, HS, and cardiac events in patients with FH treated with long-term cholesterol-lowering therapy.

Development and validation of a prediction model for coronary heart disease risk in depressed patients aged 20 years and older using machine learning algorithms

Background

Depression is being increasingly acknowledged as an important risk factor contributing to coronary heart disease (CHD). Currently, there is no predictive model specifically designed to evaluate the risk of coronary heart disease among individuals with depression. We aim to develop a machine learning (ML) model that will analyze risk factors and forecast the probability of coronary heart disease in individuals suffering from depression.

Methods

This research employed data from the National Health and Nutrition Examination Survey (NHANES) from 2007-2018, which included 2,085 individuals who had previously been diagnosed with depression. The population was randomly divided into a training set and a validation set, with an 8:2 ratio. Univariate and multivariate logistic regression analyses were employed to identify independent risk factors for coronary heart disease in individuals with depression. Eight machine learning algorithms were applied to the training set to construct the model, including logistic regression (LR), random forest (RF), gradient boosting machine (GBM), support vector machine (SVM), extreme gradient boosting (XGBoost), classification and regression tree (CART), k-nearest neighbors (KNN), and neural network (NNET). The validation set are used to evaluate the various performances of eight machine learning models. Several evaluation metrics were employed to assess and compare the performance of eight different machine learning models, aiming to identify the most effective algorithm for predicting coronary heart disease risk in individuals with depression. The evaluation metrics applied in this study included the area under the receiver operating characteristic (ROC) curve, calibration curve, Brier scores, decision curve analysis (DCA), and the precision-recall (PR) curve. And internally validated by the bootstrap method.

Results

Univariate and multivariate logistic regression analyses identified age, chest pain status, history of myocardial infarction, serum triglyceride levels, and education level as independent predictors of coronary heart disease risk. Eight machine learning algorithms are applied to construct the models, among which the Random Forest model has the best performance, with an (Area Under Curve) AUC of 0.987 for the random forest model in the training set, and an AUC of 0.848 for the PR curve. In the validation set, the random forest model achieves an AUC of 0.996, and an AUC of 0.960 for the PR curve, which demonstrates an excellent discriminative ability. Calibration curves indicated high congruence between observed and predicted odds, with minimal Brier scores of 0.026 and 0.021 for the training, respectively, reinforcing the model's ability to discriminate. Set and validation set, respectively, reinforcing the model's predictive accuracy. DCA curves confirmed net benefits of the random forest model across. Furthermore, the AUC of the random forest model was 0.928 after internal validation by bootstrap method, indicating that its discriminative ability is good, and the model is useful for clinical assessment of the risk of coronary heart disease in depressed people.

Conclusion

The random forest algorithm exhibited the best predictive performance, potentially aiding clinicians in assessing the risk probabilities of coronary heart disease within this population.

Association of non-insulin-dependent insulin resistance indices with lower limb artery restenosis after drug-coated balloon angioplasty

BACKGROUND

This study aimed to investigate the associations between noninsulin-dependent insulin resistance indices (NI-IRIs), including the triglyceride-glucose (TyG) index, TyG-BMI, triglyceride-to-high-density lipoprotein cholesterol ratio (TG/HDL-C), and metabolic score for insulin resistance (METS-IR), as well as the occurrence of restenosis in patients with lower extremity atherosclerotic occlusive disease after drug-coated balloon (DCB) treatment.

METHODS

The primary endpoint was restenosis within one year after the procedure, which was defined as ≥ 50% stenosis of the treated artery segment. The association between NI-IRIs and restenosis was assessed via multivariable logistic regression analysis. Restricted cubic spline (RCS) analysis was performed to quantify nonlinearity. The consistency of these associations was confirmed through subgroup and interaction analyses. Additionally, the additional predictive value of NI-IRIs beyond established risk factors for restenosis was evaluated via receiver operating characteristic (ROC) curves, the net reclassification improvement (NRI), and integrated discrimination improvement (IDI) indices.

RESULTS

Except for the TyG index, the other three NI-IRIs demonstrated nonlinear relationships with the probability of postoperative restenosis. Specifically, TG/HDL-C (inflection point: 1.48, P for nonlinearity: 0.003) exhibited a saturating effect, whereas METS-IR (inflection point: 49.30, P for nonlinearity: 0.017) and TyG-BMI (inflection point: 221.53, P for nonlinearity: 0.039) showed threshold effects. Subgroup analysis revealed that the interactions among the subgroups were not statistically significant. Furthermore, among the four NI-IRIs, the addition of the TG/HDL-C index significantly enhanced the predictive power of the base model for restenosis in ASO patients following DCB angioplasty (AUC values: 0.726 vs. 0.760, P = 0.042). The P values for the NRI and IDI were 0.001 and 0.002, respectively.

CONCLUSION

TG/HDL-C showed a saturating effect on restenosis within one year after DCB treatment in ASO patients, and METS-IR and TyG-BMI showed threshold effects. The addition of the TG/HDL-C index significantly improved the predictive ability of the base model for restenosis in ASO patients who underwent DCB angioplasty.

Clinical Significance of the Lipid Profile Ratios and Triglyceride Glucose Index in the Diagnosis of Metabolic Syndrome

Introduction: Metabolic syndrome (MetS) is a pathophysiological condition defined by a set of metabolic alterations such as hypertriglyceridemia, hyperglycemia, hypertension, low HDL-c levels, and visceral obesity. Its presence identifies people with an increased risk of developing cardiovascular diseases and type 2 diabetes; however, the lack of practical and reliable methods for its diagnosis limits the identification of people with this condition. In this sense, the objective of this study was to analyze the diagnostic utility of markers derived from the lipid profile [triglyceride-glucose (TyG) index and the ratios total cholesterol (TC)/high-density lipoprotein cholesterol (HDL-c), triglyceride (TG)/HDL-c, low-density lipoprotein cholesterol/HDL-c, fasting blood glucose (FBG)/HDL-c, and white blood cell/HDL-c] in the determination of MetS. Methods: A retrospective study was designed that included 619 individuals. A logistic regression model was used to evaluate the associations of the different markers with MetS, and the cutoff points of the markers were determined through an analysis of receiver operating characteristic curves and the Youden Index. Results: A positive and significant association was observed between all markers and the presence of MetS. The cutoff values for the markers that best predicted MetS were TyG ≥ 4.8 (sensitivity = 91.4%, specificity = 74.3%), TC/HDL-c ≥ 3.7 (sensitivity = 74.3%, specificity = 75.7%), TG/HDL-c ≥ 3.3 (sensitivity = 82.5%, specificity = 84.0%), and FBG/HDL-c ≥ 2.0 (sensitivity = 85.1%, specificity = 79.7%). Conclusion: Our study demonstrated the diagnostic relevance of the different markers in detecting MetS, suggesting that these ratios may be useful in clinical practice for the opportune and accurate diagnosis of MetS.

The mediating role of systemic inflammation and moderating role of racialization in disparities in incident dementia

BACKGROUND

Exposure to systemic racism is linked to increased dementia burden. To assess systemic inflammation as a potential pathway linking exposure to racism and dementia disparities, we investigated the mediating role of C-reactive protein (CRP), a systemic inflammation marker, and the moderating role of the racialization process in incident dementia.

METHODS

In the US Health and Retirement Study (n = 6,908), serum CRP was measured at baseline (2006, 2008 waves). Incident dementia was classified by cognitive tests over a six-year follow-up. Self-reported racialized categories were a proxy for exposure to the racialization process. We decomposed racialized disparities in dementia incidence (non-Hispanic Black and/or Hispanic vs. non-Hispanic white) into 1) the mediated effect of CRP, 2) the moderated portion attributable to the interaction between racialized group membership and CRP, and 3) the controlled direct effect (other pathways through which racism operates).

RESULTS

The 6-year cumulative incidence of dementia is 12%. Among minoritized participants (i.e., non-Hispanic Black and/or Hispanic), high CRP levels ( ≥ 75th percentile or 4.73μg/mL) are associated with 1.26 (95%CI: 0.98, 1.62) times greater risk of incident dementia than low CRP ( < 4.73μg/mL). Decomposition analysis comparing minoritized versus non-Hispanic white participants shows that the mediating effect of CRP accounts for 3% (95% CI: 0%, 6%) of the racial disparity, while the interaction effect between minoritized group status and high CRP accounts for 14% (95% CI: 1%, 27%) of the disparity. Findings are robust to potential violations of causal mediation assumptions.

CONCLUSIONS

Minoritized group membership modifies the relationship between systemic inflammation and incident dementia.

Effectiveness of anthocyanin-containing foods and nutraceuticals in mitigating oxidative stress, inflammation, and cardiovascular health-related biomarkers: a systematic review of animal and human interventions

Cardiovascular diseases (CVDs) are a group of chronic health disorders prevalent worldwide that claim millions of lives yearly. Inflammation and oxidative stress are intricately associated with myocardial tissue damage, endothelial dysfunction, and increased odds of heart failure. Thus, dietary strategies aimed at decreasing the odds of CVDs are paramount. In this regard, the consumption of anthocyanins, natural pigments found in edible flowers, fruits, and vegetables, has attracted attention due to their potential to promote cardiovascular health. The main mechanisms of action linked with their protective effects on antioxidant and anti-inflammatory activities, serum lipid profile modulation, and other cardiovascular health parameters are explained and exemplified. However, little is known about the dose-dependency nature of the effects, which anthocyanin has better efficiency, and whether anthocyanin-containing foods display better in vivo efficacy than nutraceuticals (i.e., concentrated extracts containing higher levels of anthocyanins than foods). Thus, this systematic review focused on determining the effects of anthocyanin-containing foods and nutraceuticals on biomarkers associated with CVDs using animal studies and human interventions supported by in vitro mechanistic insights. Overall, the results showed that the regular consumption of anthocyanin-containing foods and nutraceuticals improved vascular function, lipid profile, and antioxidant and anti-inflammatory effects. The daily dosage, the participants' health status, and the duration of the intervention also significantly influenced the results.

Exogenous exposures shape genetic predisposition to lipids, Alzheimer's, and coronary heart disease in the MLXIPL gene locus

Associations of single nucleotide polymorphisms (SNPs) of the MLXIPL lipid gene with Alzheimer's (AD) and coronary heart disease (CHD) and potentially causal mediation effects of their risk factors, high-density lipoprotein cholesterol (HDL-C) and triglycerides (TG), were examined in two samples of European ancestry from the US (22,712 individuals 587/2,608 AD/CHD cases) and the UK Biobank (UKB) (232,341 individuals; 809/15,269 AD/CHD cases). Our results suggest that these associations can be regulated by several biological mechanisms and shaped by exogenous exposures. Two patterns of associations (represented by rs17145750 and rs6967028) were identified. Minor alleles of rs17145750 and rs6967028 demonstrated primary (secondary) association with high TG (lower HDL-C) and high HDL-C (lower TG) levels, respectively. The primary association explained ~50% of the secondary one suggesting partly independent mechanisms of TG and HDL-C regulation. The magnitude of the association of rs17145750 with HDL-C was significantly higher in the US vs. UKB sample and likely related to differences in exogenous exposures in the two countries. rs17145750 demonstrated a significant detrimental indirect effect through TG on AD risk in the UKB only (βIE = 0.015, pIE = 1.9 × 10-3), which suggests protective effects of high TG levels against AD, likely shaped by exogenous exposures. Also, rs17145750 demonstrated significant protective indirect effects through TG and HDL-C in the associations with CHD in both samples. In contrast, rs6967028 demonstrated an adverse mediation effect through HDL-C on CHD risk in the US sample only (βIE = 0.019, pIE = 8.6 × 10-4). This trade-off suggests different roles of triglyceride mediated mechanisms in the pathogenesis of AD and CHD.

The Mediating Role of Systemic Inflammation and Moderating Role of Race/Ethnicity in Racialized Disparities in Incident Dementia: A Decomposition Analysis

Background

Exposure to systemic racism is linked to increased dementia burden. To assess systemic inflammation as a potential pathway linking exposure to racism and dementia disparities, we investigated the mediating role of C-reactive protein (CRP), a systemic inflammation marker, and the moderating role of race/ethnicity on racialized disparities in incident dementia.

Methods

In the US Health and Retirement Study (n=5,143), serum CRP was measured at baseline (2006, 2008 waves). Incident dementia was classified by cognitive tests over a six-year follow-up. Self-reported racialized categories were a proxy for exposure to the racialization process. We decomposed racialized disparities in dementia incidence (non-Hispanic Black and/or Hispanic vs. non-Hispanic White) into 1) the mediated effect of CRP, 2) the moderated portion attributable to the interaction between racialized group membership and CRP, and 3) the controlled direct effect (other pathways through which racism operates).

Results

The 6-year cumulative incidence of dementia was 15.5%. Among minoritized participants (i.e., non-Hispanic Black and/or Hispanic), high CRP levels (> 75th percentile or 4.57mcg/mL) was associated with 1.27 (95%CI: 1.01,1.59) times greater risk of incident dementia than low CRP (<4.57mcg/mL). Decomposition analysis comparing minoritized versus non-Hispanic White participants showed that the mediating effect of CRP accounted for 2% (95% CI: 0%, 6%) of the racial disparity, while the interaction effect between minoritized group status and high CRP accounted for 12% (95% CI: 2%, 22%) of the disparity. Findings were robust to potential violations of causal mediation assumptions.

Conclusions

Systemic inflammation mediates racialized disparities in incident dementia.

The Mediating Role of Systemic Inflammation and Moderating Role of Race/Ethnicity in Racialized Disparities in Incident Dementia: A Decomposition Analysis

Background

Exposure to systemic racism is linked to increased dementia burden. To assess systemic inflammation as a potential pathway linking exposure to racism and dementia disparities, we investigated the mediating role of C-reactive protein (CRP), a systemic inflammation marker, and the moderating role of race/ethnicity on racialized disparities in incident dementia.

Methods

In the US Health and Retirement Study (n=5,143), serum CRP was measured at baseline (2006, 2008 waves). Incident dementia was classified by cognitive tests over a six-year follow-up. Self-reported racialized categories were a proxy for exposure to the racialization process. We decomposed racialized disparities in dementia incidence (non-Hispanic Black and/or Hispanic vs. non-Hispanic White) into 1) the mediated effect of CRP, 2) the moderated portion attributable to the interaction between racialized group membership and CRP, and 3) the controlled direct effect (other pathways through which racism operates).

Results

The 6-year cumulative incidence of dementia was 15.5%. Among minoritized participants (i.e., non-Hispanic Black and/or Hispanic), high CRP levels (> 75th percentile or 4.57μg/mL) was associated with 1.27 (95%CI: 1.01,1.59) times greater risk of incident dementia than low CRP (≤4.57μg/mL). Decomposition analysis comparing minoritized versus non-Hispanic White participants showed that the mediating effect of CRP accounted for 2% (95% CI: 0%, 6%) of the racial disparity, while the interaction effect between minoritized group status and high CRP accounted for 12% (95% CI: 2%, 22%) of the disparity. Findings were robust to potential violations of causal mediation assumptions.

Conclusions

Systemic inflammation mediates racialized disparities in incident dementia.

Association Between Triglycerides and Incident Cognitive Impairment in Black and White Adults in the Reasons for Geographic and Racial Differences in Stroke Study

Background Elevated nonfasting triglycerides were associated with non-Alzheimer dementia in a recent study. However, this study neither evaluated the association of fasting triglycerides with incident cognitive impairment (ICI) nor adjusted for high-density lipoprotein cholesterol or hs-CRP (high-sensitivity C-reactive protein), known risk markers for ICI and dementia. Methods and Results We examined the association between fasting triglycerides and ICI among 16 170 participants in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study without cognitive impairment or a history of stroke at baseline in 2003 to 2007 and who had no stroke events during follow-up through September 2018. Overall, 1151 participants developed ICI during the median follow-up of 9.6 years. The relative risk for ICI associated with fasting triglycerides of ≥150 mg/dL versus <100 mg/dL including adjustment for age and geographic region of residence was 1.59 (95% CI, 1.20-2.11) among White women and 1.27 (95% CI, 1.00-1.62) among Black women. After multivariable adjustment, including adjustment for high-density lipoprotein cholesterol and hs-CRP, the relative risk for ICI associated with fasting triglycerides ≥150 mg/dL versus <100 mg/dL was 1.50 (95% CI, 1.09-2.06) among White women and 1.21 (95% CI, 0.93-1.57) among Black women. There was no evidence of an association between triglycerides and ICI among White or Black men. Conclusions Elevated fasting triglycerides were associated with ICI in White women after full adjustment including high-density lipoprotein cholesterol and hs-CRP. The current results suggest that the association between triglycerides and ICI is stronger in women than men.

Race-Dependent Association of High-Density Lipoprotein Cholesterol Levels With Incident Coronary Artery Disease

BACKGROUND

Plasma lipids are risk factors for coronary heart disease (CHD) in part because of race-specific associations of lipids with CHD.

OBJECTIVES

The purpose of this study was to understand why CHD risk equations underperform in Black adults.

METHODS

Between 2003 and 2007, the REGARDS (REasons for Geographic and Racial Differences in Stroke) cohort recruited 30,239 Black and White individuals aged ≥45 years from the contiguous United States. We used Cox regression models adjusted for clinical and behavioral risk factors to estimate the race-specific hazard of plasma lipid levels with incident CHD (myocardial infarction or CHD death).

RESULTS

Among 23,901 CHD-free participants (57.8% White and 58.4% women, mean age 64 ± 9 years) over a median 10 years of follow-up, 664 and 951 CHD events occurred among Black and White adults, respectively. Low-density lipoprotein cholesterol and triglycerides were associated with increased risk of CHD in both races (P interaction by race >0.10). For sex-specific clinical HDL-C categories: low HDL-C was associated with increased CHD risk in White (HR: 1.22; 95% CI: 1.05-1.43) but not in Black (HR: 0.94; 95% CI: 0.78-1.14) adults (P interaction by race = 0.08); high HDL-C was not associated with decreased CHD events in either race (HR: 0.96; 95% CI: 0.79-1.16 for White participants and HR: 0.91; 95% CI: 0.74-1.12 for Black adults).

CONCLUSIONS

Low-density lipoprotein cholesterol and triglycerides modestly predicted CHD risk in Black and White adults. Low HDL-C was associated with increased CHD risk in White but not Black adults, and high HDL-C was not protective in either group. Current high-density lipoprotein cholesterol-based risk calculations could lead to inaccurate risk assessment in Black adults.

Relationship between obesity-related parameters and chronic kidney disease in middle-aged and elderly populations in Taiwan: A community-based study

Globally, obesity is a major health problem and can markedly increase the risk of various diseases, including type 2 diabetes mellitus, hypertension (HTN), dyslipidemia, and chronic kidney disease (CKD). The association of obesity-related parameters, such as lipid parameters and their ratio, with CKD in clinical settings is not well understood. This study aimed to investigate the association of obesity-related parameters with CKD in the middle-aged and elderly population in Taiwan. This cross-sectional, community-based study recruited 400 participants (141 males and 259 females) aged 50 years or over from a community health promotion project at the Linkou Chang Gung Memorial Hospital (Guishan District, Taoyuan City) in 2014. Each participant completed a questionnaire including personal information and medical history during a face-to-face interview. Laboratory data were obtained from blood and urine sampling. The data were analyzed using t-test, chi-square test, Pearson's correlation test, multivariate logistic regression, and receiver operating characteristic (ROC) analysis. A total of 81 participants were identified as having CKD [estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m² or urine albumin/creatinine ratio ≥30 mg/g], and their mean triglyceride/high-density lipoprotein cholesterol (TG/HDL-C) ratio was 3.37 ± 2.72. The mean TG/HDL-C ratio of the 319 participants without CKD was 2.35 ± 1.66. After adjusting for age, TG/HDL-C was significantly positively correlated with blood pressure, body mass index, waist circumference, and fasting plasma glucose but not low-density lipoprotein cholesterol. There was a negative correlation between TG/HDL-C and eGFR. Multiple logistic regression model analysis showed that TG/HDL-C was still significantly associated with CKD (OR: 1.17, 95% CI: 1.01–1.36, p = 0.04) after adjusting for multiple covariates. The cut-off point of TG/HDL-C as a predictor of CKD was 2.54 with an area under the ROC curve of 0.61 (95% CI: 0.53–0.68). There was a significant positive correlation between TG/HDL-C and several cardiovascular disease risk factors, including obesity indices. The TG/HDL-C ratio was significantly associated with the risk of CKD and demonstrated predictive ability for CKD in the middle-aged and elderly population. Further studies on its application in clinical settings are warranted.