Triglycerides / HDL Ratio - Kresser Institute Membership Site

Marker Name: Triglycerides/HDL Ratio

REFERENCE RANGES FOR TRIGLYCERIDE/HDL RATIO:

Laboratory reference range: 0–3.8

Functional reference range: 0–2

DESCRIPTION:

The ratio between triglycerides and HDL cholesterol (triglycerides/HDL ratio) can be used to help predict the atherogenicity of plasma.^1-3 The ratio of triglycerides to HDL tends to correlate with myocardial infarction risk.⁴ Moreover, this ratio can be used to estimate atherogenic dyslipidemia and its associated residual cardiovascular risk in patients with type 2 diabetes mellitus.⁵ The prevalence of macroangiopathy, insulin resistance, loss of pancreatic beta cell function, and non-LDL related macrovascular risk can also be estimated using this ratio.⁵

Triglycerides can be absorbed from dietary sources or synthesized by intestinal cells from free fatty acids and glycerol.^6-8 Triglycerides can also be liberated by adipocytes via lipolysis as a rapid source of energy.⁹ Lipolysis is tightly regulated by circulating insulin, epinephrine, and norepinephrine.⁹

HDL primarily participates in the reverse cholesterol transport pathway.¹⁰ HDL is synthesized by the liver and collects cholesterol from adipocytes and atherosclerotic plaques.¹⁰ The nascent HDL particle matures as cholesterol is enzymatically esterified and incorporated into the lipoprotein particle.¹⁰ In fact, the triglyceride/HDL ratio correlates with both cholesterol esterification rate and lipoprotein particle size.³ At the end of the particle’s lifespan, HDL is degraded and metabolized by the liver, and excess cholesterol is excreted in the bile.¹¹

Blood triglyceride levels may increase by an order of magnitude after a meal. Thus, the triglyceride/HDL ratio is only clinically relevant when it is measured in the plasma of fasting individuals.¹²

The triglyceride/HDL cholesterol ratio is usually elevated in cases of abnormally high triglyceride levels and/or abnormally low HDL cholesterol levels in the blood. Presumably, any state that would alter lipid levels in these ways could elevate this ratio. The ratio has been studied most extensively as a marker for cardiovascular risk and, as such, has been shown to be elevated in conditions that are associated with elevated cardiovascular risk such as obesity, hypertension, diabetes mellitus, hypothyroidism, and smoking.^1,2,5,6,13 For reasons that are not entirely clear, elevations in this ratio have also been correlated to certain mental health illnesses such as major depression and bipolar disorder.⁴

Since the triglyceride/HDL ratio is a means to assess atherogenic potential, the ratio cannot be too low. Relative reductions in total cholesterol and elevations in HDL cholesterol are considered healthy.¹³

Triglycerides and HDL cholesterol are directly measured in a standard serum lipid profile. The ratio is calculated from these two measured values.¹⁴

PATHOLOGICAL/CONVENTIONAL RANGE INDICATIONS: High in:^2,4,5,15-17

Hypertension
Obesity
Hyperinsulinemia
Insulin resistance
Metabolic syndrome
Coronary heart disease
Diabetes mellitus
Hypothyroidism
Smoking

Low in:

Not clinically relevant

FUNCTIONAL RANGE INDICATIONS:

High in:

Early stages of indications listed in conventional range section

Low in:

Inflammation (with very high HDL) and/or autoimmune disease (with very low triglycerides)

References: