Elevated triglyceride/high-density lipoprotein-cholesterol ratio as a risk factor for progression to prediabetes: a 5-year retrospective cohort study in Japan.

Purpose: The triglyceride-to-high-density lipoprotein-cholesterol (TG/HDL-C) ratio is considered an alternative marker for insulin resistance. This longitudinal retrospective study investigated the relationship between TG/HDL-C ratio and the risk of progression to prediabetes.

Methods: We investigated 24,604 Japanese participants (14,609 men and 9,995 women) who underwent annual medical health checkups in 2017 (baseline) and 2022. All participants had no diabetes and prediabetes at baseline. No lipid-lowering medications were taken during the follow-up period. Participants were divided into four groups according to the quartiles of TG/HDL-C ratio at baseline. Multivariable-adjusted Cox regression analysis was conducted to examine hazard ratios (HRs) of progression to prediabetes. Receiver operating characteristic curves were used to determine the optimal cutoff value of TG/HDL-C ratio for prediction of prediabetes.

Results: Compared with the lowest TG/HDL-C ratio quartile (Q1) group, the adjusted HRs (95% confidence intervals (CI)) of progression to prediabetes in the Q2, Q3, and Q4 groups, respectively, were 1.17 (0.92-1.47), 1.26 (1.01-1.56), and 1.77 (1.41-2.23) for men and 1.07 (0.60-1.11), 1.19 (1.08-1.29), and 1.58 (1.18-2.31) for women. For every 1 unit increase in TG/HDL-C ratio, the adjusted HRs (95% CI) for progression to prediabetes was 1.09 (1.04-1.13) in men and 1.10 (1.04-1.15) in women. The optimal TG/HDL-C ratio cutoffs were 1.71 and 0.97 in men and women, respectively, but the area under the curve was > 0.70 in both sexes.

Conclusion: High TG/HDL-C ratio is a risk factor for progression to prediabetes in Japanese men and women, but it had low discriminative ability in predicting prediabetes risk.

Supplementary Information: The online version contains supplementary material available at 10.1007/s40200-023-01329-8.