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

• Main Authors: Cesar Higgins Tejera (Author), Jessica Minnier (Author), Sergio Fazio (Author), Monika M Safford (Author), Lisandro D. Colantonio (Author), Marguerite R Irvin (Author), Virginia Howard (Author), Neil A Zakai (Author), Nathalie Pamir (Author)
• Format: Book
• Published: Elsevier, 2021-09-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.
• Notes: 2666-6677; 10.1016/j.ajpc.2021.100198
• Keywords: TG/HDL ratio; Dyslipidemia; CAD; CHD; Vascular Inflammation; hsCRP; Diseases of the circulatory (Cardiovascular) system; RC666-701; Public aspects of medicine; RA1-1270
• Source: American Journal of Preventive Cardiology, Vol 7, Iss , Pp 100198- (2021)

Objective: Black adults are less likely than White adults to present with adverse lipid profiles and more likely to present with low-grade inflammation. The impact of race on the association between atherogenic lipid profiles, inflammation, and coronary heart disease (CHD) is unknown. Methods: We evaluated the association between high levels (>50th percentile) of high-sensitivity C-reactive protein (hsCRP) and of triglycerides to high density lipoprotein ratio (TG/HDL-C) and CHD events by race in the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort with 30,239 Black and White participants aged 45 and older. Results: Participants with both high hsCRP and high TG/HDL-C had highest rates of CHD (HR 1.84; 95% CI: 1.48, 2.29 vs HR 1.52; 95% CI: 1.19, 1.94 in White vs Black participants respectively). Whereas isolated high hsCRP was associated with increased CHD risk in both races (HR 1.68; 95% CI: 1.31, 2.15 and HR 1.43; 95% CI: 1.13, 1.81 for White and Black participants respectively), isolated high TG/HDL was associated with increased CHD risk only in White participants (HR 1.44; 95% CI: 1.15, 1.79 vs HR 1.01; 95% CI: 0.74, 1.38). Further, the effects of high hsCRP and high TG/HDL-C were additive, with inflammation being the driving variable for the association in both races. Conclusion: In both races, higher inflammation combined with adverse lipid profile is associated with greater CHD risk. Therefore, inflammation increases CHD risk in both races whereas dyslipidemia alone is associated with a greater risk in White but not in Black adults. hsCRP testing should be a standard feature of CHD risk assessment, particularly in Black patients.