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Triglyceride/HDL Ratio Predicts Heart Attacks, Diabetes

Published: January 15, 2016

~Dr. Gabe Mirkin's Fitness and Health e-Zine 

Two blood tests that are done during routine physical exams can be used to predict whether you are at increased risk for a heart attack (The Journal of Clinical Hypertension, Jan 13, 2016). It's called the triglyceride/HDL ratio, calculated by dividing your triglycerides number by your HDL number.

  • Your triglycerides should be below 150 mg/dL (in Canada less than 1.7 mmol/L)
  • Your HDL cholesterol should be above 40 (in Canada, greater than 1.00 mmol/L)
  • Thus your Triglycerides/HDL ratio should be under 3.75

The triglycerides/HDL ratio also predicts risk for diabetes and pre-diabetes (J Investig Med, Feb 2014;62(2):345-9). Almost fifty percent of North American adults already have diabetes or pre-diabetes (JAMA, September 8, 2015), diseases that damage every cell in your body to cause heart attacks, strokes, dementia, impotence, many cancers, blindness, deafness, and premature death. If your triglyceride/HDL ratio is above 3.75, you are at increased risk for pre-diabetes or diabetes. Check with your doctor. Since the majority of cases of diabetes are caused by a faulty lifestyle, not just by genetics, diabetes is both a preventable and curable disease with lifestyle changes. Many people with pre-diabetes and early diabetes can return to normal by changing their lifestyles long before they develop any symptoms of the disease.

Why Triglyceride/HDL Ratio Predicts Diabetes

Doctors screen for diabetes by ordering a fasting blood sugar. However, some people with pre-diabetes have normal fasting blood sugar levels. The first thing that happens when you start to become diabetic is that your blood sugar rises too high after you eat, even if your fasting blood sugar is normal. If your blood sugar is greater than 140 two hours after you eat, you are at least pre-diabetic, even if all your other tests are normal.

High Triglycerides: When your blood sugar rises too high, your liver converts the extra sugar into a fat called triglycerides, so an early sign of diabetes is a triglyceride level above 150 mg/dL (above 1.7 mmol/L in Canada).

Low HDL Cholesterol: High blood fat levels can cause clots and heart attacks, so you use your good HDL cholesterol to carry triglycerides from your bloodstream to your liver. A low HDL cholesterol is another early sign of diabetes.

Fatty Liver: Your HDL cholesterol carries extra fat from your bloodstream to your liver. Too much fat stored in your liver is called a fatty liver. Your liver is supposed to prevent blood sugar levels from rising too high. When blood sugar levels rise, the pancreas releases insulin which lowers high blood sugar levels by driving sugar from the bloodstream into the liver. However, if you have a fatty liver, it does not accept the sugar, so blood sugar levels remain high to cause diabetes.

You Can Check Your Own Triglyceride/HDL Ratio

Look at your most recent blood tests for your triglyceride and HDL cholesterol numbers. If your triglyceride/HDL ratio is greater than 3.75, you are likely to be at least pre-diabetic. If you can also pinch more than three inches of fat under the skin on your belly, you may already be diabetic. Check with your doctor. Realize that you cannot cure diabetes with drugs alone; you must change your lifestyle to prevent or cure diabetes:

  • exercise
  • lose weight if overweight
  • restrict foods and drinks with added sugars, fried foods, red meat and processed meats
  • eat more fruits and vegetables
  • get blood levels of hydroxy vitamin D above 50 nmol/L

Note: Pre-diabetics and diabetics can have triglyceride/HDL ratios under 3.75. Your doctor will probably do additional tests for your diagnosis and treatment. A more dependable test is blood sugar taken two hours after you eat. If this is above 140, you are at least pre-diabetic.

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