Dr. Kumar’s Take:
Many people believe that lowering their LDL cholesterol is enough to protect their heart—but this study tells a deeper story. Researchers found that the triglyceride to HDL cholesterol ratio (TG/HDL-C) is a powerful marker for heart disease, stroke, and metabolic syndrome, even when LDL is under control. This simple blood test could help catch risk earlier and personalize prevention.
Actionable Tip: Ask your doctor about your TG/HDL ratio next time you get blood work. A higher number may mean higher risk—even if everything else looks “normal.”
Key Takeaways:
✔ TG/HDL-C ratio is a strong predictor of metabolic syndrome and cardiovascular disease.
✔ It can reveal residual risk even when LDL is well-controlled with statins.
✔ Cut-off values vary by sex, ethnicity, and region, but generally values over 2.5 in men and 1.5 in women are considered higher risk.
✔ This ratio is inexpensive and can be calculated from a basic lipid panel.
Brief Summary:
This large review article published in Diagnostics looked at how the TG/HDL-C ratio connects to metabolic syndrome (MetS) and different types of cardiovascular disease (CVD), including coronary artery disease, peripheral artery disease, and stroke. The authors reviewed dozens of studies showing that a high TG/HDL ratio often means higher risk, even when LDL cholesterol is low due to statins.
This ratio was especially useful in predicting:
- Metabolic syndrome and insulin resistance
- Major heart events like heart attacks
- Peripheral artery disease and how severe it might be
- Certain types of stroke, especially in younger patients
Study Design:
This was a review article that summarized findings from over 30 clinical studies involving thousands of patients across multiple countries. It focused on the relationship between the TG/HDL-C ratio and health risks like diabetes, obesity, coronary artery disease, peripheral artery disease, and stroke.
The researchers looked at how this ratio performed across different age groups, genders, and ethnicities and evaluated its ability to predict adverse outcomes or help guide prevention.
Results:
- High TG/HDL-C ratio is linked with higher insulin resistance and metabolic syndrome.
- The ratio predicted future heart attacks, even in patients with normal LDL levels.
- Higher ratios were tied to more complex and severe peripheral artery disease.
- Some studies found that it also predicted stroke risk and brain changes, especially in younger adults.
- Different cut-offs were proposed, but many studies found values over 2.5 in men and 1.7 in women were concerning.
What Is the TG/HDL-C Ratio?
The TG/HDL-C ratio is a simple number you can get by dividing your triglyceride level by your HDL cholesterol. You don’t need a special test—just your regular cholesterol panel.
- Triglycerides: A type of fat found in your blood.
- HDL Cholesterol: The “good” cholesterol that helps remove harmful cholesterol from your body.
A high TG and low HDL means your ratio is higher—which has been shown to relate to insulin resistance, inflammation, and cardiovascular risk.
Related Studies and Research
ASCVD Risk Equation May Overestimate Heart Disease – Reviews evidence suggesting that standard risk calculators may overstate actual cardiovascular risk.
Statins and Diabetes Risk: A Review – Investigates the potential connection between statin therapy and increased diabetes risk.
Coronary Artery Calcium and Statin Allocation – Explores how CAC scoring can help personalize statin therapy decisions.
ApoB vs. LDL Cholesterol: Which is the Better Risk Marker? – Compares ApoB and LDL cholesterol as predictors of cardiovascular disease.
TG/HDL-C Ratio and Cardiovascular Risk – Explores the significance of the triglyceride-to-HDL cholesterol ratio in assessing cardiovascular and metabolic risk.
Frequently Asked Questions
What is a good TG/HDL ratio?
While there’s no universal cut-off, many studies suggest:
- <2.0 is ideal
- >2.5 in men or >1.7 in women may signal higher risk
Is this more important than LDL?
Not necessarily, but LDL is only part of the story. The TG/HDL ratio gives extra information about residual risk—especially in people already on statins.
Can lifestyle changes improve the ratio?
Yes! Losing weight, exercising, and eating fewer refined carbs can all lower triglycerides and raise HDL—improving your ratio naturally.
Should I get this ratio checked?
If you’re getting a routine lipid panel, you already have the data! Ask your doctor to calculate the TG/HDL ratio for you.
Conclusion
This comprehensive review makes one thing clear: the TG/HDL-C ratio is a powerful, easy-to-measure marker that can help spot early risk for heart disease, stroke, and metabolic issues. It adds another layer of insight beyond LDL alone and is especially helpful for catching problems before symptoms appear.