Comparison of discrimination for cardio-metabolic risk by different cut-off values of the ratio of triglycerides to HDL cholesterol

Lipids Health Dis. 2019 Jul 27;18(1):156. doi: 10.1186/s12944-019-1098-0.


Background: The ratio of triglycerides to HDL cholesterol (TG/HDL-C ratio) is known as a good predictor for cardiovascular disease. The purpose of this study was to compare discrimination for cardiovascular risk by different cut-off values of the TG/HDL-C ratio.

Methods: Receiver operating characteristic (ROC) analysis was performed for the relationship between TG/HDL-C ratio and accumulation of cardio-metabolic risk factors including visceral obesity, hypertension and diabetes. Logistic regression analysis was performed for the relationships of TG/HDL-C ratio with cardio-metabolic risk factors using the cut-off values obtained by ROC analysis and conventional cut-off values (men, 3.75; women, 3.00).

Results: In ROC analysis, the optimal cut-off values for TG/HDL-C ratio were 2.967 in men and 2.237 in women, which were much smaller than the conventional cut-of values. Odds ratios for multiple cardio-metabolic risk factors of subjects with vs. subjects without a high TG/HDL-C ratio in men and women were 5.75 (4.43-7.46) and 18.76 (10.32-34.13), respectively, by using the new cut-off values and they were 5.03 (3.96-6.39) and 16.11 (9.20-28.20), respectively, by using the conventional cut-off values. The odds ratios for visceral obesity, hypertension and diabetes were comparable when using these two different cut-off values.

Conclusion: Cut-off values should be ideally calculated by ROC analysis. However, the discrimination power of cut-off values for the TG/HDL-C ratio calculated by ROC analysis for cardio-metabolic risk was similar to those by using the conventional cut-off values. Further studies using cardiovascular events as outcomes in the analysis may be needed to determine more suitable cut-off values of the TG/HDL-C ratio.

Keywords: Cardiovascular disease; Cut-off values; Multiple risk factors; Receiver operating characteristic; Triglycerides-to-HDL cholesterol ratio.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Cardiovascular Diseases / blood
  • Cardiovascular Diseases / etiology
  • Cholesterol, HDL / blood*
  • Diabetes Mellitus / blood*
  • Diabetes Mellitus / etiology
  • Female
  • Humans
  • Hypertension / blood*
  • Hypertension / etiology
  • Logistic Models
  • Male
  • Obesity, Abdominal / blood*
  • Obesity, Abdominal / etiology
  • Odds Ratio
  • ROC Curve
  • Risk Factors
  • Triglycerides / blood*


  • Cholesterol, HDL
  • Triglycerides