Comparison between European and Iranian cutoff points of triglyceride/high-density lipoprotein cholesterol concentrations in predicting cardiovascular disease outcomes

Published:October 24, 2015DOI:


      High triglyceride (TG) and low high-density lipoprotein cholesterol (HDL-C) are important cardiovascular risk factors. The exact prognostic value of the TG/HDL-C ratio, a marker for cardiovascular events, is currently unknown among Iranians so this study sought to determine the optimal cutoff point for the TG/HDL-C ratio in predicting cardiovascular disease events in the Iranian population.


      The Isfahan Cohort Study (ICS) is an ongoing, longitudinal, population-based study that was originally conducted on adults aged ≥35 years, living in urban and rural areas of three districts in central Iran. After 10 years of follow-up, 5431 participants were re-evaluated using a standard protocol similar to the one used for baseline. At both measurements, participants underwent medical interviews, physical examinations, and fasting blood measurements. “High-risk” subjects were defined by the discrimination power of indices, which were assessed using receiver operating characteristic (ROC) analysis; the optimal cutoff point value for each index was then derived.


      The mean age of the participants was 50.7 ± 11.6 years. The TG/HDL-C ratio, at a threshold of 3.68, was used to screen for cardiovascular events among the study population. Subjects were divided into two groups (“low” and “high” risk) according to the TG/HDL-C concentration ratio at baseline. A slightly higher number of high-risk individuals were identified using the European cutoff points of 63.7% in comparison with the ICS cutoff points of 49.5%. The unadjusted hazard ratio (HR) was greatest in high-risk individuals identified by the ICS cutoff points (HR = 1.54, 95% CI [1.33–1.79]) vs European cutoff points (HR = 1.38, 95% [1.17–1.63]). There were no remarkable changes after adjusting for differences in sex and age (HR = 1.58, 95% CI [1.36–1.84] vs HR = 1.44, 95% CI [1.22–1.71]) for the ICS and European cutoff points, respectively.


      The threshold of TG/HDL ≥3.68 is the optimal cutoff point for predicting cardiovascular events in Iranian individuals.


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        • Giannini S.D.
        • Forti N.
        • Issa J.S.
        • Diament J.
        [The value of the treatment of dyslipidemias in the prognosis of patients with coronary artery disease].
        Arq Bras Cardiol. 1995; 65: 297-299
        • Hammoudeh A.J.
        • Izraiq M.
        • Al-Mousa E.
        • et al.
        Serum lipid profiles with and without CAD: Jordan Hyperlipidaemia and Related Targets Study (JoHARTS-1).
        East Mediterr Health J. 2008; 14: 24-32
        • Castelli W.P.
        Cholesterol and lipids in the risk of coronary artery disease–the Framingham Heart Study.
        Can J Cardiol. 1988; 4: 5A-10A
        • Gotto Jr., A.M.
        Treatment of hyperlipidemia.
        Am J Cardiol. 1986; 57: 11G-16G
        • Gotto Jr., A.M.
        Triglyceride as a risk factor for coronary artery disease.
        Am J Cardiol. 1998; 82: 22Q-25Q
        • Igweh J.C.
        • Nwagha I.U.
        • Okaro J.M.
        The effects of menopause on the serum lipid profile of normal females of South East Nigeria.
        Niger J Physiol Sci. 2005; 20: 48-53
        • Frohlich J.
        • Dobiasova M.
        Fractional esterification rate of cholesterol and ratio of triglycerides to HDL-cholesterol are powerful predictors of positive findings on coronary angiography.
        Clin Chem. 2003; 49: 1873-1880
        • Brites F.D.
        • Bonavita C.D.
        • Cloes M.
        • et al.
        VLDL compositional changes and plasma levels of triglycerides and high density lipoprotein.
        Clin Chim Acta. 1998; 269: 107-124
        • Salazar M.R.
        • Carbajal H.A.
        • Espeche W.G.
        • et al.
        Comparison of the abilities of the plasma triglyceride/high-density lipoprotein cholesterol ratio and the metabolic syndrome to identify insulin resistance.
        Diab Vasc Dis Res. 2013; 10: 346-352
        • Salazar M.R.
        • Carbajal H.A.
        • Espeche W.G.
        • et al.
        Relation among the plasma triglyceride/high-density lipoprotein cholesterol concentration ratio, insulin resistance, and associated cardio-metabolic risk factors in men and women.
        Am J Cardiol. 2012; 109: 1749-1753
        • Salazar M.R.
        • Carbajal H.A.
        • Espeche W.G.
        • Aizpurua M.
        • Maciel P.M.
        • Reaven G.M.
        Identification of cardiometabolic risk: visceral adiposity index versus triglyceride/HDL cholesterol ratio.
        Am J Med. 2014; 127: 152-157
        • Salazar M.R.
        • Carbajal H.A.
        • Espeche W.G.
        • et al.
        Identifying cardiovascular disease risk and outcome: use of the plasma triglyceride/high-density lipoprotein cholesterol concentration ratio versus metabolic syndrome criteria.
        J Intern Med. 2013; 273: 595-601
        • Talaei M.
        • Sarrafzadegan N.
        • Sadeghi M.
        • et al.
        Incidence of cardiovascular diseases in an Iranian population: the Isfahan Cohort Study.
        Arch Iran Med. 2013; 16: 138-144
        • Sarrafzadegan N.
        • Talaei M.
        • Sadeghi M.
        • et al.
        The Isfahan cohort study: rationale, methods and main findings.
        J Hum Hypertens. 2011; 25: 545-553
        • Gharipour M.
        • Sarrafzadegan N.
        • Sadeghi M.
        • et al.
        Predictors of metabolic syndrome in the Iranian population: waist circumference, body mass index, or waist to hip ratio?.
        Cholesterol. 2013; 2013: 198384
        • Friedewald W.T.
        • Levy R.I.
        • Fredrickson D.S.
        Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge.
        Clin Chem. 1972; 18: 499-502
        • Boshtam M.
        • Ramezani M.A.
        • Naderi G.
        • Sarrafzadegan N.
        Is Friedewald formula a good estimation for low-density lipoprotein level in Iranian population?.
        J Res Med Sci. 2012; 17: 519-522
        • Perkins N.J.
        • Schisterman E.F.
        The inconsistency of “optimal” cutpoints obtained using two criteria based on the receiver operating characteristic curve.
        Am J Epidemiol. 2006; 163: 670-675
        • Hadaegh F.
        • Khalili D.
        • Ghasemi A.
        • Tohidi M.
        • Sheikholeslami F.
        • Azizi F.
        Triglyceride/HDL-cholesterol ratio is an independent predictor for coronary heart disease in a population of Iranian men.
        Nutr Metab Cardiovasc Dis. 2009; 19: 401-408
        • Mulukutla S.R.
        • Venkitachalam L.
        • Marroquin O.C.
        • et al.
        Population variations in atherogenic dyslipidemia: A report from the HeartSCORE and IndiaSCORE Studies.
        J Clin Lipidol. 2008; 2: 410-417
        • Kulkarni K.R.
        • Markovitz J.H.
        • Nanda N.C.
        • Segrest J.P.
        Increased prevalence of smaller and denser LDL Particles Asian Indians.
        Arterioscler Thromb Vasc Biol. 1999; 19: 2749-2755
        • Perry A.C.
        • Applegate E.B.
        • Jackson M.L.
        • et al.
        Racial differences in visceral adipose tissue but not anthropometric markers of health-related variables.
        J Applphysiol (1985). 2000; 89: 636-643
        • Allayee H.
        • Dominguez K.M.
        • Aouizerat B.E.
        • et al.
        Contribution of the hepatic lipase gene to the atherogenic lipoprotein phenotype in familial combined hyperlipidemia.
        J Lipid Res. 2000; 41: 245-252
        • Zambon A.
        • Deeb S.S.
        • Hokanson J.E.
        • Brown B.G.
        • Brunzell J.D.
        Common variants in the promoter of the hepatic lipase gene are associated with lower levels of hepatic lipase activity, buoyant LDL, and higher HDL2 cholesterol.
        Arterioscler Thromb Vasc Biol. 1998; 18: 1723-1729
        • Barzi F.
        • Patel A.
        • Woodward M.
        • et al.
        A comparison of lipid variables as predictors of cardiovascular disease in the Asia Pacific region.
        Ann Epidemiol. 2005; 15: 405-413
        • McLaughlin T.
        • Abbasi F.
        • Cheal K.
        • Chu J.
        • Lamendola C.
        • Reaven G.
        Use of metabolic markers to identify overweight individuals who are insulin resistant.
        Ann Intern Med. 2003; 139: 802-809
        • Gharipour M.
        • Sadeghi M.
        • Dianatkhah M.
        • et al.
        The cut-off values of anthropometric indices for identifying subjects at risk for metabolic syndrome in Iranian elderly men.
        J Obes. 2014; 2014: 907149
      1. Triglyceride, high-density lipoprotein, and coronary heart disease.
        Consens Statement. 1992; 10: 1-28
        • Matsuzawa Y.
        • Shimomura I.
        • Nakamura T.
        • Keno Y.
        • Kotani K.
        • Tokunaga K.
        Pathophysiology and pathogenesis of visceral fat obesity.
        Obes Res. 1995; 3: 187S-194S