Triglyceride to HDL-Cholesterol Ratio and the Incident Risk of Ischemic Heart Disease Among Koreans Without Diabetes: A Prospective Study Using National Health Insurance Data

Background: Early insulin resistance without diabetes can cause cardiovascular disease, which is a public health challenge. This study aimed to investigate the effects of the triglyceride to high-density lipid (HDL)-cholesterol ratio (TG/HDL-C), which could reflect insulin resistance from the beginning, on the incident risk of ischemic heart disease (IHD). Methods: We assessed 16,455 individuals (8,426 men and 8,029 women) without diabetes in a community-dwelling Korean cohort using National Health Insurance data. Participants were classified based on the TG/HDL-C quartiles. Using multivariate Cox proportional-hazards regression models, we prospectively examined the hazard ratios (HRs) with 95% confidence intervals (CIs) for IHD over 50 months after baseline enrolment. Results: During the follow-up period, 321 (2.0%) participants developed IHD. After adjusting for potential confounding variables, the HRs of IHD for TG/HDL-C quartiles were 1.00, 1.61 (95% CI, 1.05-2.48), 1.85 (95% CI, 1.21-2.81), and 2.29 (95% CI, 1.50-3.51), respectively. Compared with men, women showed higher HRs for the risk of incident IHD in the fourth quartile [HR (95% CI) = 2.98 [1.50-5.88] and 1.80 [1.02-3.17], respectively). Compared with metabolic syndrome, TG/HDL-C had a more powerful predictive value for IHD. Conclusions: In Koreans without diabetes, an increased TG/HDL-C precedes future IHD. Additionally, sex differences may merit serious consideration when interpreting TG/HDL-C for assessing cardiovascular risks in clinical practice.