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TG/HDL-C Ratio as a Superior Diagnostic Biomarker for Coronary Plaque Burden in First-Time Acute Coronary Syndrome

Fatih Aydin1, Bektaş Murat1, Selda Murat2

  • 1Department of Cardiology, Eskisehir City Hospital, 26080 Eskisehir, Türkiye.

Diagnostics (Basel, Switzerland)
|September 13, 2025
PubMed

Insights

The TG/HDL-C ratio is a better predictor of coronary plaque burden than LDL-C in acute coronary syndrome patients. This lipid ratio offers a cost-effective tool for assessing plaque extent during initial evaluations.

Area of Science:

  • Cardiology
  • Lipidology
  • Diagnostic Biomarkers

Background:

  • Current acute coronary syndrome (ACS) risk assessment relies heavily on LDL-C, but its accuracy in reflecting coronary plaque burden is limited.
  • Investigating advanced lipid profiles, particularly the TG/HDL-C ratio, may offer improved diagnostic capabilities for significant coronary plaque in treatment-naïve ACS patients.

Purpose of the Study:

  • To evaluate the TG/HDL-C ratio as a diagnostic marker for coronary plaque burden in first-time ACS patients.
  • To compare the efficacy of the TG/HDL-C ratio against LDL-C in predicting extensive coronary plaque.

Main Methods:

  • Analysis of 376 treatment-naïve ACS patients undergoing PCI with complete lipid data.
  • Quantification of coronary plaque burden using quantitative coronary angiography (QCA) and stratification by lesion count.
  • Measurement of lipid levels and ratios (LDL-C, HDL-C, TC, TG, LDL/HDL-C, TC/HDL-C, TG/HDL-C) with statistical analysis including logistic regression and ROC analysis.

Main Results:

  • The TG/HDL-C ratio demonstrated a significant progressive increase with higher coronary plaque burden (lesion count).
  • The TG/HDL-C ratio was identified as an independent predictor of high plaque burden (OR 1.25, p=0.004), outperforming LDL-C.
  • ROC analysis indicated the superior diagnostic performance of the TG/HDL-C ratio.

Conclusions:

  • The TG/HDL-C ratio serves as a more effective diagnostic biomarker than LDL-C for identifying extensive coronary plaque burden in ACS patients.
  • Incorporating the TG/HDL-C ratio into initial lipid profiling provides a valuable, cost-effective tool for risk stratification.

Keywords:
acute coronary syndromeatherosclerosiscoronary plaque burdendiagnostic biomarkerslipid ratiosrisk stratification

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