The goal of this study was to evaluate the ability of various routine measures of
lipoprotein metabolism to identify patients who were insulin resistant and dyslipidemic,
and therefore, at increased risk of cardiovascular disease. For this purpose, insulin
resistance was quantified by determining the steady-state plasma glucose concentration
during the insulin suppression test in 449 apparently healthy patients. The low-density
lipoprotein (LDL) particle diameter and subclass phenotype were measured by gradient
gel electrophoresis in 1,135 patients. Pearson’s correlation coefficients and receiver-operating
characteristic curves were used to evaluate measures of lipoprotein metabolism as
potential markers of insulin resistance and LDL phenotype. The results indicated that
the ratio of the plasma concentrations of triglyceride to high-density lipoprotein
cholesterol was the best predictor of insulin resistance and LDL particle diameter.
The optimal triglyceride/high-density lipoprotein cholesterol ratio for predicting
insulin resistance and LDL phenotype was 3.5 mg/dl; a value that identified insulin-resistant
patients with a sensitivity and specificity comparable to the criteria currently proposed
to diagnose the metabolic syndrome. The sensitivity and specificity were even greater
for identification of patients with small, dense, LDL particles. In conlusion, a plasma
triglyceride/high-density lipoprotein cholesterol concentration ratio ≥3.5 provides
a simple means of identifying insulin-resistant, dyslipidemic patients who are likely
to be at increased risk of cardiovascular disease.
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Article info
Publication history
Published online: June 20, 2005
Accepted:
March 29,
2005
Received in revised form:
March 29,
2005
Received:
December 28,
2004
Footnotes
Dr. Krauss was supported by a grant from the National Dairy Council, Rosemont, Illinois. Drs. Krauss, Waters, Saad, and Simon were supported by Grant U01-HL6975, Drs. McLaughlin, Reaven, Abbasi, and Ms. Lamendola were supported by Grant RR000070, and Dr. McLaughlin was supported by Grant RR16071-01 from the National Institutes of Health, Bethesda, Maryland. The funding sources had no role in the design, conduct, or manuscript preparation for this study.
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© 2005 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
