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.