The Role of Triglyceride to HDL Cholesterol Ratio in Sera as a Clinical Surrogate Marker for Cardiovascular Risk and Insulin Resistance in Patients with Metabolic Syndrome

The study aimed to investigate the triglycerides to HDL-cholesterol ratio (Tg/HDL) and the interaction of this ratio with insulin resistance (IR) and insulin secretion indices, with the levels of interleukin - 1(IL-1), interleukin-6 (Il-6), and tumour necrotic factor-α (TNF-α) in sera among patients with metabolic syndrome (MS). A prospective, cross-sectional, comparative study was conducted on 45 patients with MS without data for hyperglycemia and 21 metabolically healthy non-obese controls. The levels of fasting and postprandial glucose, immunoreactive insulin (IRI), total cholesterol, triglycerides (Tg), IL-1, IL-6, and TNF-α were measured in all the participants. We calculated the LDL cholesterol levels, Tg/HDL ratio, homeostatic model of insulin resistance (HOMA-IR), and the homeostatic model of β-cell function (HOMA-b). Patients with MS had higher BMI (38.73±1.84 vs. 24.32±2.71 kg/m2; р<0.05) and waist circumference (115.56 ±4.7 vs. 81.1±8.4cm; р<0.05) than non-obese controls. The same patients had higher LDL cholesterol levels (3.42±0.3 vs. 2.63±0.66 mmol/l; р<0.05) and Tg (1.59±0.22 vs. 1.08±0.31mmol/l; р<0.05), as well as lower levels of HDL-cholesterol (1.03±0.09 vs. 1.27 ± 0.24mmol/l; р<0.05) compared to the controls. The Tg/HDL ratio was 2.03±0.87 among the patients with MS and 0.88±0.27 in controls; р<0.05. The plasma levels of basal IRI (19.32±3.22 mIU/l vs. 9.13±0.73mIU/l; р<0.05), HOMA-IR (4.02 vs. 1.97; р<0.05) and HOMA-b (258.77±57.76 vs. 183.31±17.52; р<0.05) were significantly higher in the MS group. The same patients with MS had higher concentrations of IL-1 (18.37±4.28pg/ml vs. 7.12±1.74pg/ml; p<0.05), IL-6 (1.01±0.3pg/ml vs. 0.1±0.3pg/ml; р<0.05) and TNF-α (2.13±1.43 pg/ml vs. 1.82±0.94pg/ml; р=0.24) too. Positive correlations between the levels of IL-1 and Tg/HDL ratio (r= 0.46; p=0.008), IL-1 and HOMA-%В (r=0.47; p=0.005) were found. The Tg/HDL ratio is a potential, cheap and available surrogate marker for screening for cardiovascular risk and insulin resistance in patients with MS in clinical practice.