Research Blog

December 8, 2022

Lipid Biomarkers: Triglyceride to HDL Ratio

Optimal Takeaways

The ratio of triglycerides to HDL-C (TG:HDL) provides information about lipid metabolism and cardiometabolic risk. An elevated ratio reflects a relative increase in triglycerides and decrease in HDL and is associated with glucose intolerance, metabolic syndrome, hypertension, CVD, and major adverse cardiovascular events. A low level is desirable in general though may increase risk of 3-month mortality following ischemic stroke.

Conventional Lab Range: 0.00 - 2.00 ratio

Optimal Dx’s Optimal Range: 0.50 - 1.90 ratio    

Low TG:HDL-C ratio is associated with a decreased risk of cardiometabolic disease, though may be associated with increased 3-month mortality following ischemic stroke (Deng 2019).

High TG:HDL-C ratio is associated with impaired glucose tolerance, insulin resistance, metabolic syndrome, dyslipidemia, hypertension, cardiovascular disease (Hajian-Tilaki 2020), atherosclerosis (Scicali 2021), increased risk of MACE and all-cause mortality following coronary angiography (Sultani 2020), NAFLD (Fan 2019), and periodontitis (Gomes-Filho 2021).


The triglyceride to HDL-C ratio reflects risk of cardiovascular disease, impaired glucose tolerance, type 2 diabetes, insulin resistance, metabolic syndrome, atherogenic dyslipidemia, and hypertension. In one cross-sectional population-based study of 567 subjects, a TG:HDL above 3.6 indicated a significantly increased risk of cardiovascular disease while an overall cut-off below 2.7 suggested decreased risk (Hajian-Tilaki 2020). Elevated TG:HDL reflects smaller, denser, more atherogenic LDL particles as well (Wakabayashi 2019).

Review of annual health check-up data in 10,196 Japanese men and women 35-40 years old investigated the association of TG:HDL with cardiometabolic risk factors. Researchers suggested individual cut-offs values for TG:HDL of 2.97 in men and 2.23 in women to identify cardiovascular risk characterized by multiple CVD risk factors including visceral obesity, diabetes, and hypertension (Wakabayashi 2019). A TG:HDL above 3.3 in adolescents is highly suggestive of metabolic syndrome and should be investigated further (Chu 2019).

A 5-year follow-up study of 482 coronary angiography patients found that a TG:HDL of 2.5 or above was associated with a significantly greater risk of major adverse cardiac events and all-cause mortality (Sultani 2020). Review of annual health data in a cross-sectional study of 1,068 individuals found that TG:HDL was associated with increased atherogenic malondialdehyde-modified LDL and small dense LDLs. The most desirable cut-offs for TG:HDL were 1.85 in men and 0.88 in women (Moriyama 2020).

A cut-off of 2.2 was recommended to identify individuals with insulin resistance in a cross-sectional population-based study of older Taiwanese subjects suggests. Increased BMI, hypertension, and diabetes were also significantly associated with insulin resistance in the study (Yeh 2019).

An increasing TG:HDL was associated with incident non-alcoholic fatty liver disease as well. Those diagnosed with NAFLD had a mean TG:HDL of 1.8 while those without NAFLD had a mean ratio of 0.7 (Fan 2019).

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Chu, Shou-Yu et al. “Risk assessment of metabolic syndrome in adolescents using the triglyceride/high-density lipoprotein cholesterol ratio and the total cholesterol/high-density lipoprotein cholesterol ratio.” Annals of pediatric endocrinology & metabolism vol. 24,1 (2019): 41-48. doi:10.6065/apem.2019.24.1.41

Gomes-Filho, Isaac S et al. “Periodontitis and its higher levels of severity are associated with the triglyceride/high density lipoprotein cholesterol ratio.” Journal of periodontology vol. 92,11 (2021): 1509-1521. doi:10.1002/JPER.21-0004

Fan, Nengguang et al. “Triglycerides to high-density lipoprotein cholesterol ratio as a surrogate for nonalcoholic fatty liver disease: a cross-sectional study.” Lipids in health and disease vol. 18,1 39. 2 Feb. 2019, doi:10.1186/s12944-019-0986-7

Hajian-Tilaki, Karimollah et al. “Triglyceride to high-density lipoprotein cholesterol and low-density lipoprotein cholestrol to high-density lipoprotein cholesterol ratios are predictors of cardiovascular risk in Iranian adults: Evidence from a population-based cross-sectional study.” Caspian journal of internal medicine vol. 11,1 (2020): 53-61. doi:10.22088/cjim.11.1.53

Moriyama, Kengo. “The Association between the Triglyceride to High-density Lipoprotein Cholesterol Ratio and Low-density Lipoprotein Subclasses.” Internal medicine (Tokyo, Japan) vol. 59,21 (2020): 2661-2669. doi:10.2169/internalmedicine.4954-20

Scicali, Roberto et al. “High TG to HDL ratio plays a significant role on atherosclerosis extension in prediabetes and newly diagnosed type 2 diabetes subjects.” Diabetes/metabolism research and reviews vol. 37,2 (2021): e3367. doi:10.1002/dmrr.3367

Sultani, Rohullah et al. “Elevated Triglycerides to High-Density Lipoprotein Cholesterol (TG/HDL-C) Ratio Predicts Long-Term Mortality in High-Risk Patients.” Heart, lung & circulation vol. 29,3 (2020): 414-421. doi:10.1016/j.hlc.2019.03.019

Wakabayashi, Ichiro, and Takashi Daimon. “Comparison of discrimination for cardio-metabolic risk by different cut-off values of the ratio of triglycerides to HDL cholesterol.” Lipids in health and disease vol. 18,1 156. 27 Jul. 2019, doi:10.1186/s12944-019-1098-0

Yeh, Wei-Chung et al. “Elevated triglyceride-to-HDL cholesterol ratio is an indicator for insulin resistance in middle-aged and elderly Taiwanese population: a cross-sectional study.” Lipids in health and disease vol. 18,1 176. 11 Oct. 2019, doi:10.1186/s12944-019-1123-3

Tag(s): Biomarkers

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