The triglyceride/HDL cholesterol ratio and TyG index predict coronary atherosclerosis and outcome in the general population

The combination of increased plasma triglycerides (TGs) and low high-density lipoprotein cholesterol (HDL-C) is an emerging marker of 'atherogenic dyslipidaemia' and risk of cardiovascular events in the general population.1 The TG-glucose (TyG) index is calculated as Ln(TG*FPG/2).2 It predicted cardiac events in the general population,3 and the progression of coronary atherosclerosis in patients with known coronary artery disease,4 irrespective of other risk factors, or cholesterol levels. In a cohort from the general population, we investigated specifically the interplay between TG-related indices, findings from non-contrast computed tomography (CT) and patient outcome. From CT scans, epicardial fat volume (EFV) and coronary artery calcium (CAC) score were derived. Epicardial fat is a biologically active organ that surrounds the coronary arteries and promote the development of coronary atherosclerosis.5 EFV then becomes a surrogate indicator of the lipid-rich coronary plaque burden, and then of high-risk atherosclerotic plaques, while the CAC score expresses more stable and calcific coronary atherosclerosis. EFV may have also a prognostic value for future adverse events also beyond CAC scoring.6