Gaziano 1997: TG/HDL Ratio Predicts Heart Attack Risk

Background

The Gaziano 1997 study was one of the first to systematically evaluate the triglyceride-to-HDL ratio as a cardiovascular risk predictor, helping establish its clinical utility.

The Study

Researchers from Harvard Medical School and Brigham and Women's Hospital conducted a case-control study:

• •340 myocardial infarction patients from six Boston-area hospitals
• •340 matched controls without heart attack
• •Fasting lipid profiles measured in all participants

Key Findings

The results demonstrated remarkable predictive power of the TG/HDL ratio:

• •Crude triglyceride association: Elevated fasting triglycerides showed strong crude association with MI risk (RR 6.8 in highest vs lowest quartile)
• •After HDL adjustment: Relationship remained significant but attenuated (RR 2.7)
• •TG/HDL ratio: The ratio emerged as the most powerful predictor with relative risk of 16.0 comparing highest to lowest quartile

Clinical Impact

This study was pivotal in establishing several key concepts:

1. •Ratio superiority: Neither triglycerides nor HDL alone predicted risk as effectively as their ratio
2. •Metabolic relationship: The ratio captures the underlying pattern of atherogenic dyslipidemia better than single measurements
3. •Beyond LDL: Helps explain why some patients with "normal" LDL still have heart attacks

The dramatic 16-fold relative risk difference helped establish the TG/HDL ratio as one of the most powerful lipid-based cardiovascular risk predictors available from routine blood work.