April 2, 2025BMC Cardiovascular Disorders6 citationsOpen Access

High triglyceride-to-high-density lipoprotein cholesterol ratio predicts poor prognosis in new-onset heart failure: a retrospective study

JWJunfei WengNanchang University WDWei DongUniversity of British Columbia Hospital RLRuichun LiaoNanchang University

Structured PICO

Does a high TG/HDL-C ratio predict an increased risk of MACE in patients with new-onset heart failure?

Population

614 adults (aged 18-90 years) with new-onset heart failure, mean age 68.94, 59.12% male. Mean LVEF 46.59% (45.11% HFrEF, 26.71% HFmrEF, 28.18% HFpEF). Excluded patients with severe organ dysfunction (eGFR <30), recent glucocorticoid use, suspected familial hypertriglyceridemia, or extreme BMI (≥45 kg/m²).

Intervention

High triglyceride-to-high-density lipoprotein cholesterol (TG/HDL-C) ratio (evaluated as a continuous variable and by quartiles, with Quartile 4 >1.80)

Comparator

Lower TG/HDL-C ratio (Quartiles 1-3, with Quartile 1 ≤0.71 serving as the reference group)

Outcome

Major adverse cardiovascular events (MACE), defined as a composite of cardiovascular death and heart failure rehospitalizations within 12 months after dischargecomposite

An elevated TG/HDL-C ratio is an independent predictor of 12-month MACE in patients with new-onset heart failure, suggesting its utility as a simple, cost-effective biomarker for early risk stratification.

Abstract

BACKGROUND: There is limited research on the relationship between the triglyceride-to-high-density lipoprotein cholesterol (TG/HDL-C) ratio and outcomes in new-onset heart failure (HF). Therefore, this study aimed to explore the association between TG/HDL-C ratio and clinical outcomes in these patients. METHODS: A retrospective cohort of 614 adults with new-onset HF hospitalized at The First Affiliated Hospital of Nanchang University between July 2021 and December 2022 was analyzed. The primary endpoint was major adverse cardiovascular events (MACE), defined as cardiovascular (CV) death and HF rehospitalizations within 12 months after discharge. Kaplan-Meier (K-M) curves, restricted cubic spline (RCS) analysis, and Cox regression evaluated the association between TG/HDL-C ratio and MACE risk. RESULTS: Patients were divided into four quartiles (Quartile 1, 2,3 and 4) based on their TG/HDL-C ratios. The mean age was 68.94 ± 14.34 years, with 59.12% male. The mean left ventricular ejection fraction (LVEF) was 46.59 ± 10.89%, with 45.11% having an LVEF ≤ 40%. During the 12-month follow-up, 156 patients experienced MACE, comprising 18 CV deaths and 138 HF rehospitalizations. The Quartile 4 group had the highest MACE risk incidence compared to other groups (P < 0.001). K-M analysis confirmed that the Quartile 4 group was associated with an increased cumulative incidence of MACE, HF rehospitalization, and CV death (all P < 0.001). RCS analysis revealed a positive nonlinear relationship between the TG/HDL-C ratio and MACE risk (P for nonlinear = 0.026), with a sharp risk increase above a ratio of 1.08. After adjustment, TG/HDL-C ratio was independently associated with MACE (HR: 1.44, 95% CI: 1.29-1.60). Compared to Quartile 1, adjusted HRs were significantly higher in Quartiles 2, 3, and 4 (all P < 0.005). CONCLUSIONS: The TG/HDL-C ratio is independently associated with 12-month MACE risk in new-onset HF patients. It may serve as a simple, cost-effective marker to improve early risk stratification and guide closer monitoring and tailored management in this high-risk population.

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