Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Association of triglycerides to high-density lipoprotein-cholesterol ratio with risk of incident hypertension

Abstract

The triglyceride to high-density lipoprotein-cholesterol (TG/HDL-C) ratio is considered a simple surrogate of insulin resistance. The aim of this study was to explore the association of the TG/HDL-C ratio with the risk of incident hypertension and whether the TG/HDL-C ratio mediates the obesity–incident hypertension association. The study analyzed 9679 participants from a rural Chinese population. Demographic and anthropometric and laboratory data were collected at baseline (2007–2008) and follow-up (2013–2014) examinations. A multivariate logistic regression model was used to analyze the association of the TG/HDL-C ratio with incident hypertension, estimating odds ratios (ORs) and 95% confidence intervals (CIs). Mediation analysis was performed to examine the contribution of the TG/HDL-C ratio to obesity-related incident hypertension. During a median follow-up of 6.00 years, hypertension developed in 1880/9679 participants (19.42%). The risk of incident hypertension was higher in the highest TG/HDL-C ratio quartile than in the lowest quartile (OR = 1.21, 95% CI = 1.02–1.42). Subgroup analyses showed that the risk of incident hypertension was increased by 30%, 36%, and 33% among women, participants < 60 years old and those with prehypertension at baseline, respectively. The TG/HDL-C ratio partially mediated the obesity–incident hypertension association (indirect effect: OR = 1.04, 95% CI: 1.01–1.07; direct effect: OR = 1.36, 95% CI: 1.16–1.62). The TG/HDL-C ratio may be a risk factor for incident hypertension, especially in women, participants < 60 years old and those with prehypertension. The TG/HDL-C ratio may also play a mediating role in obesity-related incident hypertension.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Prices vary by article type

from$1.95

to$39.95

Prices may be subject to local taxes which are calculated during checkout

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2224–60.

    PubMed  PubMed Central  Google Scholar 

  2. Mills KT, Bundy JD, Kelly TN, Reed JE, Kearney PM, Reynolds K, et al. Global disparities of hypertension prevalence and control: a systematic analysis of population-based studies from 90 countries. Circulation. 2016;134:441–50.

    PubMed  PubMed Central  Google Scholar 

  3. Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: analysis of worldwide data. Lancet. 2005;365:217–23.

    PubMed  Google Scholar 

  4. Lawes CM, Vander HS, Rodgers A. Global burden of blood-pressure-related disease, 2001. Lancet. 2008;371:1513–8.

    PubMed  Google Scholar 

  5. Forouzanfar Mh AAALT. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388:1659–724.

    Google Scholar 

  6. Wang F, Han L, Hu D. Fasting insulin, insulin resistance and risk of hypertension in the general population: a meta-analysis. Clin Chim Acta. 2017;464:57–63.

    CAS  PubMed  Google Scholar 

  7. Han T, Lan L, Qu R, Xu Q, Jiang R, Na L, et al. Temporal relationship between hyperuricemia and insulin resistance and its impact on future risk of hypertension. Hypertension. 2017;70:703–11.

    CAS  PubMed  Google Scholar 

  8. Singh B, Saxena A. Surrogate markers of insulin resistance: a review. World J Diabetes. 2010;1:36–47.

    PubMed  PubMed Central  Google Scholar 

  9. Abbasi F, Reaven GM. Comparison of two methods using plasma triglyceride concentration as a surrogate estimate of insulin action in nondiabetic subjects: triglycerides × glucose versus triglyceride/high-density lipoprotein cholesterol. Metabolism. 2011;60:1673–6.

    CAS  PubMed  Google Scholar 

  10. Gaziano JM, Hennekens CH, O’Donnell CJ, Breslow JL, Buring JE. Fasting triglycerides, high-density lipoprotein, and risk of myocardial infarction. Circulation. 1997;96:2520–5.

    CAS  PubMed  Google Scholar 

  11. Li HY, Chen BD, Ma YT, Yang YN, Ma X, Liu F, et al. Optimal cutoff of the triglyceride to high-density lipoprotein cholesterol ratio to detect cardiovascular risk factors among Han adults in Xinjiang. J Health Popul Nutr. 2016;35:30.

    PubMed  PubMed Central  Google Scholar 

  12. Zoppini G, Targher G, Negri C, Stoico V, Gemma ML, Bonora E. Usefulness of the triglyceride to high-density lipoprotein cholesterol ratio for predicting mortality risk in type 2 diabetes: role of kidney dysfunction. Atherosclerosis. 2010;212:287–91.

    CAS  PubMed  Google Scholar 

  13. Bittner V, Johnson BD, Zineh I, Rogers WJ, Vido D, Marroquin OC, et al. The triglyceride/high-density lipoprotein cholesterol ratio predicts all-cause mortality in women with suspected myocardial ischemia: a report from the Women’s Ischemia Syndrome Evaluation (WISE). Am Heart J. 2009;157:548–55.

    CAS  PubMed  PubMed Central  Google Scholar 

  14. Sanchez-Inigo L, Navarro-Gonzalez D, Pastrana-Delgado J, Fernandez-Montero A, Martinez JA. Association of triglycerides and new lipid markers with the incidence of hypertension in a Spanish cohort. J Hypertens. 2016;34:1257–65.

    CAS  PubMed  Google Scholar 

  15. Tohidi M, Hatami M, Hadaegh F, Azizi F. Triglycerides and triglycerides to high-density lipoprotein cholesterol ratio are strong predictors of incident hypertension in Middle Eastern women. J Hum Hypertens. 2012;26:525–32.

    CAS  PubMed  Google Scholar 

  16. Ghorpade DS, Ozcan L, Zheng Z, Nicoloro SM, Shen Y, Chen E, et al. Hepatocyte-secreted DPP4 in obesity promotes adipose inflammation and insulin resistance. Nature. 2018;555:673–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  17. Samuel VT, Shulman GI. Mechanisms for insulin resistance: common threads and missing links. Cell. 2012;148:852–71.

    CAS  PubMed  PubMed Central  Google Scholar 

  18. Zhao Y, Zhang M, Luo X, Wang C, Li L, Zhang L, et al. Association of 6-year waist circumference gain and incident hypertension. Heart. 2017;103:1347–52.

    PubMed  Google Scholar 

  19. Craig CL, Marshall AL, Sjostrom M, Bauman AE, Booth ML, Ainsworth BE, et al. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003;35:1381–95.

    PubMed  Google Scholar 

  20. Zhou B. Predictive values of body mass index and waist circumference to risk factors of related diseases in Chinese adult population. Chin J Epidemiol. 2002; 23:5–10.

  21. Perloff D, Grim C, Flack J, Frohlich ED, Hill M, McDonald M, et al. Human blood pressure determination by sphygmomanometry. Circulation. 1993;88:2460–70.

    CAS  PubMed  Google Scholar 

  22. Crim MT, Yoon SS, Ortiz E, Wall HK, Schober S, Gillespie C, et al. National surveillance definitions for hypertension prevalence and control among adults. Circ-Cardiovasc Qual. 2012;5:343–51.

    Google Scholar 

  23. Wen J, Huang Y, Lu Y, Yuan H. Associations of non-high-density lipoprotein cholesterol, triglycerides and the total cholesterol/HDL-c ratio with arterial stiffness independent of low-density lipoprotein cholesterol in a Chinese population. Hypertens Res. 2019;42:1223–30.

    CAS  PubMed  Google Scholar 

  24. Salazar MR, Carbajal HA, Espeche WG, Leiva SCE, Balbin E, Dulbecco CA, et al. Relation among the plasma triglyceride/high-density lipoprotein cholesterol concentration ratio, insulin resistance, and associated cardio-metabolic risk factors in men and women. Am J Cardiol. 2012;109:1749–53.

    CAS  PubMed  Google Scholar 

  25. Hayes AF. Introduction to mediation, moderation and conditional process analysis: a regression-based approach. New York: The Guilford Press; 2013.

  26. Baron RM, Kenny DA. The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol. 1986;51:1173–82.

    CAS  PubMed  Google Scholar 

  27. Park HR, Shin SR, Han AL, Jeong YJ. The correlation between the triglyceride to high density lipoprotein cholesterol ratio and computed tomography-measured visceral fat and cardiovascular disease risk factors in local adult male subjects. Korean J Fam Med. 2015;36:335–40.

    PubMed  PubMed Central  Google Scholar 

  28. Laaksonen DE, Niskanen L, Nyyssonen K, Lakka TA, Laukkanen JA, Salonen JT. Dyslipidaemia as a predictor of hypertension in middle-aged men. Eur Heart J. 2008;29:2561–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  29. Li C, Ford ES, Meng YX, Mokdad AH, Reaven GM. Does the association of the triglyceride to high-density lipoprotein cholesterol ratio with fasting serum insulin differ by race/ethnicity? Cardiovasc Diabetol. 2008;7:4.

    PubMed  PubMed Central  Google Scholar 

  30. Zheng XY, Liu L. Remnant-like lipoprotein particles impair endothelial function: direct and indirect effects on nitric oxide synthase. J Lipid Res. 2007;48:1673–80.

    CAS  PubMed  Google Scholar 

  31. Tsuruta M, Hashimoto R, Adachi H, Imaizumi T, Nomura G. Hyperinsulinaemia as a predictor of hypertension: an 11-year follow-up study in Japan. J Hypertens. 1996;14:483–8.

    CAS  PubMed  Google Scholar 

  32. Tack CJ, Smits P, Willemsen JJ, Lenders JW, Thien T, Lutterman JA. Effects of insulin on vascular tone and sympathetic nervous system in NIDDM. Diabetes. 1996;45:15–22.

    CAS  PubMed  Google Scholar 

  33. Morales-Villegas E. Dyslipidemia, hypertension and diabetes metaflammation. A unique mechanism for 3 risk factors. Curr Hypertens Rev. 2013;9:278–96.

    CAS  Google Scholar 

  34. Saitoh S. Insulin resistance and renin-angiotensin-aldosterone system. Nihon Rinsho. 2009;67:729–34.

    PubMed  Google Scholar 

  35. Franco OH, Massaro JM, Civil J, Cobain MR, O’Malley B, D’Agostino RB Sr. Trajectories of entering the metabolic syndrome: the framingham heart study. Circulation. 2009;120:1943–50.

    PubMed  Google Scholar 

  36. Egan BM. Insulin resistance and the sympathetic nervous system. Curr Hypertens Rep. 2003;5:247–54.

    PubMed  Google Scholar 

  37. Zemel MB. Insulin resistance vs. hyperinsulinemia in hypertension: insulin regulation of Ca2+ transport and Ca(2+)-regulation of insulin sensitivity. J Nutr. 1995;125:1738S–1743S.

    CAS  PubMed  Google Scholar 

  38. Al-Daghri NM, Al-Attas OS, Alokail MS, Alkharfy KM, Shaik NA, Draz HM, et al. Gender-specific associations between insulin resistance, hypertension, and markers of inflammation among adult Saudis with and without diabetes mellitus type 2. Adv Med Sci. 2010;55:179–85.

    CAS  PubMed  Google Scholar 

  39. Wang MY, Zhang J, Telljohann R, Jiang LQ, Wu J, Monticone RE, et al. Chronic matrix metalloproteinase inhibition retards age-associated arterial proinflammation and increase in blood pressure. Hypertension. 2012;60:459.

    CAS  PubMed  PubMed Central  Google Scholar 

  40. Jiang LQ, Zhang J, Monticone RE, Telljohann R, Wu J, Wang MY, et al. Calpain-1 regulation of matrix metalloproteinase 2 activity in vascular smooth muscle cells facilitates age-associated aortic wall calcification and fibrosis. Hypertension. 2012;60:1192.

    CAS  PubMed  PubMed Central  Google Scholar 

  41. Choi CHJ, Cohen P. How does obesity lead to insulin resistance? Elife. 2017;6:e33298.

    PubMed  PubMed Central  Google Scholar 

  42. Brown NJ. Contribution of aldosterone to cardiovascular and renal inflammation and fibrosis. Nat Rev Nephrol. 2013;9:459–69.

    CAS  PubMed  PubMed Central  Google Scholar 

  43. Xiong XQ, Chen WW, Han Y, Zhou YB, Zhang F, Gao XY, et al. Enhanced adipose afferent reflex contributes to sympathetic activation in diet-induced obesity hypertension. Hypertension. 2012;60:1280–6.

    CAS  PubMed  Google Scholar 

  44. De Boer MP, Meijer RI, Wijnstok NJ, Jonk AM, Houben AJ, Stehouwer CD, et al. Microvascular dysfunction: a potential mechanism in the pathogenesis of obesity-associated insulin resistance and hypertension. Microcirculation. 2012;19:5–18.

    PubMed  Google Scholar 

  45. Purkayastha S, Zhang G, Cai D. Uncoupling the mechanisms of obesity and hypertension by targeting hypothalamic IKK-beta and NF-kappaB. Nat Med. 2011;17:883–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  46. Do CJM, Da SAA, Cai Z, Lin S, Dubinion JH, Hall JE. Control of blood pressure, appetite, and glucose by leptin in mice lacking leptin receptors in proopiomelanocortin neurons. Hypertension. 2011;57:918–26.

    Google Scholar 

  47. Lytsy P, Ingelsson E, Lind L, Arnlov J, Sundstrom J. Interplay of overweight and insulin resistance on hypertension development. J Hypertens. 2014;32:834–9.

    CAS  PubMed  Google Scholar 

  48. Mackinnon DP, Lockwood CM, Williams J. Confidence limits for the indirect effect: distribution of the product and resampling methods. Multivar Behav Res. 2004;39:99.

    Google Scholar 

  49. Song S, Paik HY, Park M, Song Y. Dyslipidemia patterns are differentially associated with dietary factors. Clin Nutr. 2016;35:885–91.

    CAS  PubMed  Google Scholar 

  50. Bell BB, Rahmouni K. Leptin as a mediator of obesity-induced hypertension. Curr Obes Rep. 2016;5:397–404.

    PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

DL, JL, and DH substantially contributed to the design and drafting of the study and the analysis and interpretation of the data. LG, YZ, YL, XS, HL, ZY, LiL, YR, BW, CC, LeL, XC, QZ, QL, CG, GT, and MZ revised the paper critically for important intellectual content. The investigators are grateful to the dedicated participants and all research staff involved in the study. All authors were involved in the collection of data and approved the final version of the paper.

Funding

This study was supported by the National Natural Science Foundation of China (grant nos. 81373074, 81402752, and 81673260) and the Natural Science Foundation of Guangdong Province (grant no. 2017A030313452).

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jie Lu.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Liu, D., Guan, L., Zhao, Y. et al. Association of triglycerides to high-density lipoprotein-cholesterol ratio with risk of incident hypertension. Hypertens Res 43, 948–955 (2020). https://doi.org/10.1038/s41440-020-0439-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41440-020-0439-8

Keywords

Search

Quick links