Association of Plaque Burden with Insulin Resistance Represented by Triglyceride - High Density Protein Ratio

Multiple population-based studies has demonstrated that insulin resistance (IR) is strongly associated with coronary artery disease (CAD), plaque development, progression, and burden. Several surrogate biomarkers were used to assess for IR, such as hyperinsulinemic-euglycemic clamp, which still remains impractical in a clinical setting. We used simpler biomarkers as a surrogate for IR. We identified 686 participants who were prospectively enrolled in Coronary computed tomography angiography (CCTA) clinical trials. Total Stenosis Score (TSS; the sum of maximal stenosis score per segment), Segment Involvement Score (SIS; the total number of segments with any plaque), and Total Plaque Score (TPS; the sum of the plaque amount per segment) were quantified by expert readers. These are the semi-quantitative methods used to assess plaque severity and burden. Multivariate linear regression was used to examine the association of TyG/HDL ratio, as a surrogate for IR, and its association to plaque burden. In 686 subjects, the mean age was 54.6±13.9 years, 61% were male, mean body mass index (BMI) was 30.4±7.7, 54% had diabetes mellitus (DM), 62% had hyperlipidemia (HLD), 63% had hypertension (HTN), and 34% were past smokers. The mean Triglycerides level was 149.9±89.5 (mg/dL), mean HDL was 44.5±13.5, and mean Triglycerides/HDL ratio was 3.8±3.1. For every 1 unit increase in the TyG/HDL ratio, there is a 2% increase in TSS. And after adjusting for age, gender, BMI, DM, HLD, HTN, and past smoking, p=0.033. However, The TyG/HDL ratio and TPS and SIS were not significantly associated. TyG/HDL ratio is associated with Total stenosis Score. Moreover, TyG/HDL ratio is a simple metric that can be used clinically, on a daily basis to further risk stratify and identify patients at risk for CAD.