Triglycerides and low HDL cholesterol predict coronary heart disease risk in patients with stable angina

Sci Rep. 2021 Oct 20;11(1):20714. doi: 10.1038/s41598-021-00020-3.


We assessed whether high triglycerides (TG) and low high-density lipoprotein cholesterol (HDL-C) levels, expressed by an increased TG/HDL-C ratio, predict coronary atherosclerotic disease (CAD) outcomes in patients with stable angina. We studied 355 patients (60 ± 9 years, 211 males) with stable angina who underwent coronary computed tomography angiography (CTA), were managed clinically and followed for 4.5 ± 0.9 years. The primary composite outcome was all-cause mortality and non-fatal myocardial infarction. At baseline, the proportion of males, patients with metabolic syndrome, diabetes and obstructive CAD increased across TG/HDL-C ratio quartiles, together with markers of insulin resistance, hepatic and adipose tissue dysfunction and myocardial damage, with no difference in total cholesterol or LDL-C. At follow-up, the global CTA risk score (HR 1.06, 95% confidence interval (CI) 1.03-1.09, P = 0.001) and the IV quartile of the TG/HDL-C ratio (HR 2.85, 95% CI 1.30-6.26, P < 0.01) were the only independent predictors of the primary outcome. The TG/HDL-C ratio and the CTA risk score progressed over time despite increased use of lipid-lowering drugs and reduction in LDL-C. In patients with stable angina, high TG and low HDL-C levels are associated with CAD related outcomes independently of LDL-C and treatments.Trial registration. EVINCI study: NCT00979199, registered September 17, 2009; SMARTool study: NCT04448691, registered June 26, 2020.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Angina, Stable / blood*
  • Biomarkers / blood
  • Cardiomyopathies / blood
  • Cardiomyopathies / drug therapy
  • Cholesterol / blood
  • Cholesterol, HDL / blood*
  • Cholesterol, LDL / blood
  • Coronary Angiography / methods
  • Coronary Artery Disease / blood*
  • Coronary Artery Disease / etiology*
  • Female
  • Humans
  • Hypolipidemic Agents / pharmacology
  • Insulin Resistance / physiology
  • Male
  • Metabolic Syndrome / blood
  • Metabolic Syndrome / drug therapy
  • Middle Aged
  • Risk Factors
  • Triglycerides / blood*


  • Biomarkers
  • Cholesterol, HDL
  • Cholesterol, LDL
  • Hypolipidemic Agents
  • Triglycerides
  • Cholesterol

Associated data