Associação da razão triglicérides/lipoproteína de alta densidade e de seus componentes isolados com condições cardiovasculares e metabólicas em adultos do estudo ELSA-Brasil

Abstract

Cardiovascular diseases (CVDs) are the leading cause of death worldwide, being atherosclerosis their main underlying contributing factor. Dyslipidemia, which is characterized by alterations in the serum levels of lipids, is one of the most important risk factors for atherosclerosis and holds an intimate relationship with the vascular health and cardiometabolic diseases. Among other lipid particles, triglycerides (TG) and high-density lipoprotein (HDL-C) are noteworthy as an unbalance between these particles points to an atherogenic environment. Additionally, the literature supports the use of lipid ratios as risk markers, and the triglyceride/high-density lipoprotein (TG/HDL-C) ratio has been pointed as a good tool for cardiometabolic risk prediction. However, its reference values for different ethnicities, and its association with cardiometabolic conditions deserves further scientific investigation. Therefore, the main objective of the present study was to define reference values for the TG/HDL-C ratio and verify if the association between TG/HDL-C and arterial stiffness is independent on the effects of its isolated components, by analyzing the ELSA Brazil cohort study, a large sample size study performed with Brazilian adults. The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) is composed of a multicentric cohort to study diseases such as diabetes, obesity, hypertension and cardiovascular diseases in adults aged from 35 to 74 years old. In this sense, to attend this study’s objective, firstly, an apparently healthy sample, aged 35-74, was used to generate the reference values for the TG/HDL-C. Exclusion criteria were diabetes, elevated blood pressure, obesity, hypercholesterolemia, severe hypertriglyceridemia, and smoking history. The reference values obtained were tested in the general ELSA Brazil study sample, stratified by sex and ethnicity, to identify cardiometabolic conditions. Secondly, anthropometric, biochemical, and clinical data from these individuals were used to assess the associations between TG, HDL-C, and TG/HDL-C ratio with arterial stiffness, assessed via PWV. The main findings were that TG/HDL-C ratio did not change significantly with age, regardless of sex and ethnicity, but was higher in men than women. In addition, black individuals showed lower levels of TG/HDL-C as compared to other ethnic groups. TG/HDL-C percentiles were generated and ROC curve analyses showed that the cut-offs based on the 75th percentile (2.6 for men, and 1.7 for women), displayed better sensitivities and specificities for men and women, regardless of ethnicity, and that this percentile value was significantly associated with all tested cardiometabolic conditions (hypertension, diabetes, obesity, metabolic syndrome, and insulin resistance). It was also evidenced in the present study that individuals with increased levels of TG/HDL-C (third tertile) presented worse anthropometric, biochemical, and clinical profiles as compared to the individuals with lower TG/HDL-C levels. In addition, a linear association between TG, HDL-C, and TG/HDL-C ratio with the cf-PWV was observed, being the association stronger in women. After adjustments for confounders, lower levels of HDL-C were associated with increased cf-PWV in men and women, while TG was not significantly associated. Finally, TG/HDL-C was only associated with cf-PWV in women. In conclusion, the main findings of the present study highlight that the defined TG/HDL-C cut-offs (men: 2.6; women: 1.7) are reliable and showed good clinical applicability to detect cardiometabolic conditions in a multiethnic population, and that HDL-c seems to have a strong influence, while TG seems to have no influence on the TG/HDL-C association with arterial stiffness, a marker of cardiometabolic risk.