Triglycerides HDL Ratio - the Best Measure for Heart Disease Risk

May 11, 2015

The Best Cholesterol Predictor for Artery Disease 

 Reference: Gaziano Circulation 1997 Lemos de Luz Clinics Wan PLOS April 2015 

 You want to know how to predict your risk for heart disease, right? Half of us die from it, so having a bit of a warning is a useful thing.   You go to your doctor and get told that you should be on a statin. You don’t know what to say.   Should you, shouldn’t you.   That’s the conundrum. Want some guidance?   Of course! 

You want to know the single best predictor for developing heart and vascular disease.   And you want to know how to change it and manage it.   Well, that’s a tall order, and now we know the answer.   And it’s NOT your LDLs and total cholesterol. We focus on LDLs because we have a 30 billion dollar industry of lowering it with statins. The number you want is your TG(triglycerides)/HDL ratio.   The reference is above. The authors in the Clinics article took 347 high risk patients, most in their later 50s with total cholesterols over 200.   The examined the extent of their coronary artery disease by catheterization and correlated the findings with their lipids.   

Because HDLs are known to be protective, and triglycerides known to be risky, the TG/HDL ratio is an attractive summarization to look it.   What the authors found was that this ratio is more accurate than the Total Cholesterol or LDL measures, which we usually use.   This study confirms the landmark first study by Gaziano that identified this ratio as being the best. Now we have a follow up confirmation about mortality from Wan in PLOS published just last month.   They found the TG/HDL ratio to be the most predictive ratio for subsequent mortality.   

After open heart surgery, they grouped their patients into three groups by tertile, (Top third, middle and bottom) and found a 5.32 fold increased mortality for those in the top third over the bottom third. Now, here is the kicker.   You can get yourself from the top third to the bottom third in about a month with the right diet.   I’ve done it.   You have to stop eating carbohydrates that flood into your body too quickly. This confirms the hypothesis that your blood fats are completely dominated by the carbohydrates you eat.   

When you overwhelm the ability of the body to burn carbs, your insulin goes up, your liver starts to manufacture fats and your blood fats start going up.   Triglycerides reflect that you have so much fat being made that your LDLs can’t even pick it all up, so your blood starts being filled up with triglycerides. There is no drug for that. But you have choice. You can stop eating those carbs. 

 What food should you eat instead.   Ironically, exactly the foods that look like what is in your blood is what you should be eating to cure your bad blood fats: fat.   If you switch to a diet of 70% fat and less than 20 grams of carbs a day, you can cure your elevated triglycerides in the twinkling of an eye. There have been some 20 articles published confirming this concept so it’s not new, but it should be considered the main method by which we confirm your risk.   When you get your cholesterol measured, make sure you know those numbers first, not your total cholesterol or your LDLs. Focus on your HDL and your triglyceride.   And then, aim to get your ratio to ONE.   One.   1.   Yes, ONE.   With that, you will be the safest and the healthiest.   Simple.   Just stop eating carbs and remeasure and you can be safe within a month. 

 WWW. What will work for me.   I’ve done it. I wanted to lose weight so I went on a 70% fat diet. My HDLs went from 29 to 59 in just three months. (I wasn’t measuring monthly).   My triglycerides went from 103 to 49. That makes my ratio 0.83. (Down from 3.55)   Yippeee!   I am now down 30 pounds and don’t need to lose any more weight so my new challenge is to figure out food that doesn’t make me regain weight.   Last night for supper, I started with 4 oz of cream cheese so I kept my fat up. Delicious.   No bread, no potato, no rice.   Short ribs, floating in fat, and avocado salad with olive oil dressing.   Sorry you couldn’t have it with me.  

 Pop Quiz

  1. Total cholesterol is the best measure for your risk for heart attack and vascular disease. T or F                                 Answer:  If you said true, read this column over again. No, false.
  1. HDL is typically considered your “good” cholesterol. T or F                    Answer:  True
  1. The best risk measure for future cardiac mortality is your Triglyceride/HDL ratio. T or F Answer:  That’s it
  1. The means you want your triglycerides to be LESS than your HDLs. T or F                       Answer:   Perfect. With that, your risk of heart attack is less than 20% of the rest of us.
  1. The best way to have low triglycerides is to eat less carbs. T or F                          Answer:  Bingo. Eat fat instead.   And lower your risk for heart disease.
  1. That means the best way to improve your heart disease risk is to do exactly the opposite of what we have been telling your for 40 years. T or F                      Answer:   True