Ratio of triglycerides to HDL cholesterol is an indicator of LDL particle size in patients with type 2 diabetes and normal HDL cholesterol levels

OBJECTIVE - In patients with type 2 diabetes, a normal HDL cholesterol leve l does not rule out that LDL particles may be small. Although techniques fo r analyzing LDL subfractions are not likely to be used in clinical practice , a prediction of LDL size based on a regular lipid profile may be useful f or assessment of cardiovascular risk. RESEARCH DESIGN AND METHODS - Sixty patients with type 2 diabetes with acce ptable glycemic control and an HDL cholesterol level greater than or equal to1 mmol/l were recruited after cessation of lipid-altering treatments. LDL size was determined by 2-20% PAGE; patients having small LDL (n = 30) were compared with those having intermediate or large LDL (n = 30). RESULTS - Clinical characteristics, pharmacological therapies, lifestyle, a nd prevalence of diabetes-related complications were similar in both patien t groups. LDL size correlated negatively with plasma triglycerides (TGs) (R -2 = 0.52) and positively with HDL cholesterol (R-2 = 0.14). However, an in verse correlation between the TG-to-HDL cholesterol molar ratio and LDL siz e was even stronger (R-2 = 0.59). The ratio was >1.33 in 90% of the patient s with small LDL particles (95% CI 79.3-100) and 16.5% of those with larger LDI particles. A cutoff point of 1.33 for the TG-to-HDL cholesterol ratio distinguishes between patients having small LDI values better than TG cutof f of 1.70 and 1.45 mmol/l. CONCLUSIONS - The TG-to-HDL cholesterol ratio may be related to the process es involved in LDL size pathophysiology and relevant with regard to the ris k of clinical vascular disease. It may be suitable for the selection of pat ients needing an earlier and aggressive treatment of lipid abnormalities.