Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Cardiorespiratory Fitness & TG to HDL-C Ratio in CHD

Mayo Clin Proc; ePub 2017 Nov 17; Farrell, et al

Both poor cardiorespiratory fitness (CRF) and fasting blood triglyceride to high-density lipoprotein cholesterol ratio (TG:HDL-C) are significantly associated with coronary heart disease (CHD) in men, with the risk of CHD significantly attenuated in men with moderate to high CRF compared with men with low CRF. This according to a study of 40,269 men who received a comprehensive baseline clinical examination between January 1, 1978 and December 31, 2010 with CRF determined from a maximal treadmill exercise test. Participants were divided into CRF categories of low, moderate, and high fit by age group and by TG:HDL-C quartiles. Researchers found:

  • There were 556 deaths due to CHD during a mean of 16.6±9.7 years of follow-up.
  • A significant positive trend in adjusted CHD mortality was shown across decreasing CRF categories.
  • Adjusted hazard ratios were significantly higher across increasing TG:HDL-C quartiles.
  • There was a significant positive trend in CHD mortality across decreasing CRF categories in each TG:HDL-C quartile.


Farrell SW, Finley CE, Barlow CE, et al. Moderate to high levels of cardiorespiratory fitness attenuate the effects of triglyceride to high-density lipoprotein cholesterol ratio on coronary heart disease mortality in men. [Published online ahead of print November 17, 2017]. Mayo Clin Proc. doi:10.1016/j.mayocp.2017.08.015.


Small particle size LDL-cholesterol is particularly atherogenic and is associated with elevation of plasma triglyceride (TG) levels and low high-density lipoprotein cholesterol (HDL-C) levels. High ratio of TG:HDL-C is a surrogate marker for small particle size LDL, and is associated with both metabolic syndrome and type 2 diabetes. In a previous study, these same authors showed that over 15 years, men with a high baseline TG:HDL-C (>3.5) had significantly higher adjusted mortality rates than men with a normal TG:HDL-C (<3.5).1 The current study further supports the association of increasing cardiovascular risk with increasing TG:HDL-C ratios, and then further shows that for any given ratio, increased CRF is protective against the development of CHD mortality. In a separate study, these same authors reported that in men with normal TG:HDL-C, those with low CRF had an almost 3-fold increased risk of developing high TG:HDL-C ratio over 5 years compared to those with high CRF.2 It appears that high CRF is protective of developing a high TG:HDL-C ratio, and at any given ratio, is also protective against the development of coronary artery disease and cardiovascular mortality. —Neil Skolnik, MD

  1. McLaughlin T, Reaven G, Abbasi F, et al. Is there a simple way to identify insulin-resistant individuals at increased risk of cardiovascular disease? Am J Cardiol. 2005;96(3):399-404.
  2. Vega GL, Grundy SM, Barlow CE, et al. Association of triglyceride-to-high density lipoprotein cholesterol ratio to cardiorespiratory fitness in men. J Clin Lipidol. 2016;10(6):1414-1422.e1.

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