Triglyceride/High Density Lipoprotein Cholesterol Index and Future Cardiovascular Events in Diabetic Patients without Known Cardiovascular Disease

Background The triglyceride/high-density lipoprotein cholesterol (TG/HDL-C) index, calculated as TG levels divided by HDL-C levels, is suggested as a predictor of cardiovascular disease (CVD). We investigated the association between the TG/HDL-C index and initial CVD events in high-risk patients with type 2 diabetes mellitus (T2DM). Methods We analyzed the association between the TG/HDL-C index and CVD events in T2DM patients with retinopathy and hyperlipidemia without known CVD enrolled in the EMPATHY study, which compared intensive and standard statin therapy (targeting LDL-C levels <70 mg/dL and ≥100 to <120 mg/dL, respectively). Results A total of 4665 patients were divided into high (TG/HDL-C ≥2.5, n =2013) and low (TG/HDL-C <2.5, n =2652) TG/HDL-C index groups. During a median follow-up of 36.8 months, 260 CVD events occurred. The high TG/HDL-C index group had higher CVD risk compared to the low TG/HDL-C index group (HR 1.89, 95% CI 1.45–2.47, p <0.001). This association was consistent across various subgroups. However, a trend toward interaction between the TG/HDL-C index and EMPATHY treatment allocation for CVD risk was observed ( p for interaction=0.062). Intensive statin treatment was associated with reduced CVD risk compared to standard treatment in the high TG/HDL-C index group but not in the low group. Conclusions A TG/HDL-C index ≥2.5 was associated with increased CVD risk in T2DM patients with retinopathy and hyperlipidemia without a history of CVD. The TG/HDL-C index may be a predictor of CVD and indicate patients who could benefit from intensive statin treatment.