Usefulness of the triglyceride to high-density lipoprotein cholesterol ratio for predicting mortality risk in type 2 diabetes: Role of kidney dysfunction

An increased level of triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio has been identified as an independent predictor for cardiovascular events in the general population and in some groups of high-risk patients, such as type 2 diabetes. The aim of this study was to evaluate whether a high TG/HDL-C ratio is associated with an increased risk of all-cause and cardiovascular mortality in type 2 diabetic subjects, and whether this risk is modified by the presence of kidney dysfunction.We followed 3084 type 2 diabetic outpatients for a mean period of 4.9 years for the occurrence of mortality. The independent association between the TG/HDL-C ratio and all-cause and cardiovascular mortality was analyzed by Cox proportional hazard models and adjusted for several potential confounders, including kidney function measures.During follow-up, 356 (12%) participants died, 46% of whom from cardiovascular causes. Higher TG/HDL-C ratio (third vs. first tertile) was associated with an increased hazard ratio of all-cause (hazard ratio 1.51, CI 95% 1.13-2.00, p=0.005) and cardiovascular (hazard ratio 1.70, 1.12-2.59, p=0.015) mortality after adjustment for traditional risk factors, body mass index, hemoglobin A1c and medication use. After additional adjustment for renal function measures (estimated glomerular filtration rate or albuminuria), the association between the TG/HDL-C ratio and the risk of mortality was abolished.Our findings suggest that the predictive role of a high TG/HDL-C ratio in type 2 diabetes on cardiovascular and all-cause mortality might be largely mediated by the presence of kidney dysfunction.