Triglyceride/high-density lipoprotein cholesterol ratio associates major adverse cardiac and cerebrovascular events: a 13-year prospective cohort study

Few studies have been conducted to investigate the association between the triglyceride/high-density lipoprotein cholesterol (TG/HDL-C) ratio and major adverse cardiac and cerebrovascular events (MACCEs) in a predominantly male cohort from China. A prospective cohort study was conducted on a total 95,837 individuals (males account for 79.67) extracted from the Kailuan study. All individuals were grouped according to the TG/HDL-C ratio quartile. The endpoints of this study were composite MACCEs and its subtypes [non-fatal myocardial (MI), non-fatal stroke and all-cause mortality]. The Kaplan-Meier method was employed to illustrate the cumulative incidence curve. The incidence rate was reported as per 1000 person-years. To explore the impact of varying quartiles of the TG/HDL-C ratio on the risk of MACCEs, Cox proportional hazard regression analysis was conducted. Furthermore, multivariate adjusted spline regression models were applied to examine the relationship between the TG/HDL-C ratio and the risk of MACCEs. A total of 18,430 cases of composite MACCEs occurred during a 13.97-year follow-up. In brief, 1762 cases of MI, 6653 cases of stroke, and 12,524 cases of all-cause mortality were reported, respectively. The cumulative incidence and incidence rate of composite MACCEs, MI, and stroke increased with increment in the TG/HDL-C ratio (p < 0.001). In comparison to quartile 1, the hazard ratios of quartile 4 for composite MACCEs, MI, stroke, and all-cause mortality were 1.13 (95% CI 1.07-1.19), 1.55 (95% CI 1.30-1.84), 1.21 (95% CI 1.12-1.31), and 1.12 (95% CI 1.05-1.20), respectively. Multivariate adjusted spline regression models showed a nonlinear relationship between baseline TG/HDL-C ratio and risk of composite MACCEs (p for non-linearity < 0.01), MI (p for non-linearity < 0.01), stroke (p for non-linearity < 0.01), and all-cause mortality (p for non-linearity = 0.029). The TG/HDL-C ratio is significantly associated with an increased risk of MACCEs in a predominantly male cohort from northern China.