SUN-230 - Atherogenic Index and Triglyceride-HDL Ratio as Predictors of Cardiovascular Risk in Diabetes: A Case-Control Study from South India

Introduction:
Diabetes mellitus is a major public health challenge in India, with a prevalence exceeding 7%. Cardiovascular disease (CVD) is the leading cause of morbidity and mortality among individuals with diabetes. Although lipid management traditionally emphasizes LDL-C–based targets, triglyceride-related indices such as the triglyceride-to-HDL cholesterol (TG/HDL-C) ratio and atherogenic index (AI) may better reflect residual cardiovascular risk. This study evaluated lipid ratios and atherogenic indices in patients with diabetes and assessed their utility in predicting CVD risk.

Methods:
A hospital-based case–control study was conducted at a tertiary care hospital in India between February and March 2019. A total of 120 participants were enrolled, including 60 patients with diabetes and 60 age- and sex-matched non-diabetic controls. Diabetes was diagnosed using fasting blood glucose criteria. Anthropometric parameters and blood pressure were recorded. Fasting venous blood samples were analyzed for total cholesterol, triglycerides, HDL-C, LDL-C, VLDL, and plasma glucose. Lipid ratios (TG/HDL-C, LDL-C/HDL-C, TC/HDL-C) were calculated, and AI was derived as log₁₀(TG/HDL-C). Statistical analysis was performed using SPSS v16.0; p < 0.05 was considered significant.

Results:
The mean age and sex distribution were comparable between groups. Patients with diabetes had significantly higher BMI (26.16 ± 3.35 vs 22.42 ± 2.33 kg/m²; p < 0.001) and systolic blood pressure (139.08 ± 16.86 vs 120.57 ± 14.26 mmHg; p < 0.001). Total cholesterol (219.58 ± 65.33 vs 146.43 ± 25.89 mg/dL; p < 0.001), triglycerides (177.10 ± 74.28 vs 148.52 ± 42.17 mg/dL; p = 0.011), VLDL (149.10 ± 45.53 vs 70.93 ± 29.01 mg/dL; p < 0.001), TC/HDL-C (5.52 ± 4.29 vs 3.44 ± 1.27; p < 0.001), TG/HDL-C (6.79 ± 4.96 vs 3.39 ± 0.96; p < 0.001), and LDL-C/HDL-C ratios (4.62 ± 3.37 vs 1.68 ± 0.87; p < 0.001) were significantly higher in diabetic patients. LDL-C levels did not differ significantly between groups (p = 0.91). The atherogenic index was higher in diabetic patients (0.61 ± 0.36 vs 0.51 ± 0.14), showing a strong trend toward significance (p = 0.057).

Conclusion:
TG/HDL-C ratio and atherogenic index demonstrate strong associations with cardiovascular risk in patients with diabetes, even in the absence of elevated LDL-C levels. Incorporating these indices into routine lipid assessment may allow earlier identification of high-risk individuals and improve cardiovascular risk stratification in diabetes.

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