Association between Waist Circumference and Serum Triglyceride-to-HDL Ratio among Patients with Established Ischemic Heart Disease – A Cross-Sectional Study

Open Access

Abstract

Background: Central obesity is a key driver of cardiometabolic risk and is highly prevalent among patients with ischemic heart disease (IHD), particularly in South Asian populations. Waist circumference (WC) is a simple and reliable marker of visceral adiposity, while the triglyceride to high-density lipoprotein cholesterol (TG/HDL) ratio has emerged as a strong surrogate of atherogenic dyslipidemia and insulin resistance. However, data exploring the relationship between WC and TG/HDL ratio among patients with established IHD in Bangladesh remain limited.Aim of the study: To evaluate the association between waist circumference and serum TG/HDL ratio among adults with clinically established IHD attending a tertiary care hospital. Methods & Materials: This observational analytic study with a cross-sectional design was conducted at the Department of Endocrinology and Metabolism, BIRDEM General Hospital, between March 2018–November 2019 and March 2022–March 2023. A total of 90 adults with documented IHD were enrolled. Demographic and clinical data were collected using structured questionnaires. Anthropometric measurements, including BMI, waist and hip circumference, were obtained according to WHO guidelines. Fasting serum triglycerides and HDL cholesterol were measured, and the TG/HDL ratio was calculated. Participants were stratified by TG/HDL risk categories. Correlations between WC and lipid parameters were assessed using Pearson’s correlation. Multivariate linear regression identified independent predictors of TG/HDL ratio, and logistic regression evaluated factors associated with high TG/HDL ratio (≥4.0). Statistical significance was defined as p <0.05. Result: The mean age of participants was 60.8 ± 10.2 years; 51.1% were female. The majority were overweight or obese (74.4%) and had central obesity (95.6%). High TG/HDL ratio (≥4.0) was observed in 66.7% of participants. Waist circumference showed a significant positive correlation with TG (r = 0.42, p <0.001) and TG/HDL ratio (r = 0.48, p <0.001) and a negative correlation with HDL (r = −0.36, p = 0.001). Multivariate analysis demonstrated that WC (β = 0.21, p <0.001), BMI (β = 0.18, p =0.007), and diabetes mellitus (β = 0.94, p =0.011) were independent predictors of TG/HDL ratio. Participants with increased WC had 6.87-fold higher odds of high TG/HDL ratio (95% CI: 1.45–32.51, p =0.015). Conclusion: Waist circumference is strongly and independently associated with serum TG/HDL ratio in adults with IHD. Given its simplicity and low cost, routine measurement of waist circumference can serve as an effective screening tool to identify individuals at elevated cardiometabolic risk, guiding timely preventive interventions and improving risk stratification in clinical practice.