Abstract 18730: Correlates and Cut-points of the Triglyceride/HDL Cholesterol Ratio: The Very Large Database of Lipids 4 (VLDL-4)

Background: An elevated TG/HDL-C is predictive of atherosclerotic cardiovascular disease; however, advanced lipoprotein correlates of the TG/HDL-C ratio and discrimination by standard cut-points are incompletely characterized. Hypothesis: Elevated TG/HDL-C correlates most strongly with triglyceride-rich remnant lipoprotein cholesterol (RLP-C) and also with LDL density, Lp(a)-C, and male gender. Methods: We examined 1,350,908 individuals from the Very Large Database of Lipids (Baltimore, MD; NCT01698489 ) who were clinically referred for lipoprotein cholesterol ultracentrifugation (Atherotech, Birmingham, AL). LDL density was assessed as a continuous LDL density parameter (LLDR) calculated as the natural log of the ratio of dense to buoyant LDL-C subfractions. RLP-C was defined as VLDL 3 -C plus IDL-C. Results: The strongest univariate correlates of the TG/HDL-C ratio were VLDL 3 -C (spearman rho= 0.824, p<0.0001) and IDL-C (spearman rho=0.537, p<0.0001). In a multivariable linear regression model including age, gender, LLDR, Lp(a)-C, VLDL 3 -C, and IDL-C, the overall adjusted R 2 was 0.764 (p<0.0001). In this model, IDL-C was inversely correlated (partial R=-0.140, p<0.0001) while VLDL 3 -C (partial R=0.697, p<0.001) was more strongly and positively associated with TG/HDL-C. We compared demographic and lipid parameters across standard cut-points of TG/HDL-C (<3, 3-5, >5) ( Table ). Compared with the TG/HDL-C <3 group, there was a 36% higher VLDL 3 -C level in those with a TG/HDL-C of 3-5, and 73% higher level in those with a TG/HDL-C >5. There was a progressively higher LLDR across these groups characteristic of increasing LDL density. Conclusions: A higher TG/HDL ratio is correlated with an increasingly atherogenic lipid phenotype. Across increasing TG/HDL-C groups, VLDL 3 -C, IDL-C, and RLP-C increase. Non-HDL-C rises across these groups along with LDL density, despite similar LDL-C.