R. Boizel et al., Ratio of triglycerides to HDL cholesterol is an indicator of LDL particle size in patients with type 2 diabetes and normal HDL cholesterol levels, DIABET CARE, 23(11), 2000, pp. 1679-1685
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.