Study Links TG/HDL Ratio, Not TyG Index, to Arterial Stiffness in Prediabetes

Prediabetes (preD) is known to increase the risk of cardiovascular events compared to individuals with normal glucose tolerance (NGT). This heightened risk is largely due to insulin resistance, a key feature of prediabetes, which plays a major role in cardiovascular complications. To assess this risk early, researchers have increasingly turned to surrogate markers of insulin resistance, such as the triglycerides-to-HDL cholesterol ratio (TG/HDL) and the triglyceride-glucose index.

In this context, Maurizio Di Marco, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy, and colleagues explored how these markers relate to cardiovascular risk in prediabetic individuals, particularly through their association with arterial stiffness—an early indicator of vascular damage.

For this purpose, the researchers enrolled 377 individuals without a prior diagnosis of diabetes. All participants underwent comprehensive biochemical testing and an oral glucose tolerance test. To assess cardiovascular risk, measurements of arterial stiffness were taken, including pulse wave velocity (PWV), augmentation index (AugI), and intima-media thickness (IMT). Based on current clinical guidelines, the participants were categorized into three groups: those with normal glucose tolerance (NGT, n = 100), individuals with prediabetes (preD, n = 216), and those newly diagnosed with type 2 diabetes (ND-T2D, n = 61).

The study revealed the following findings:

• People with prediabetes had higher TG/HDL and TyG levels compared to those with normal glucose tolerance.
• TG/HDL levels in prediabetes were similar to those in newly diagnosed type 2 diabetes.
• Individuals with prediabetes showed greater arterial stiffness and vessel thickness, reflected by higher PWV, AugI, and IMT readings.
• In the prediabetes group, PWV showed a significant link with TG/HDL, even after accounting for major influencing factors.
• There was no clear association between PWV and TyG.
• There was a weak trend linking PWV to HOMA-IR, but it was not statistically significant.
• Those in the highest TG/HDL group were more than twice as likely to have increased PWV, suggesting a higher cardiovascular risk.

"The study highlights the potential of the triglycerides-to-HDL cholesterol ratio (TG/HDL) as a simple, non-invasive, and cost-effective marker for assessing cardiovascular risk in individuals with prediabetes," the authors wrote. They added, "The independent association between TG/HDL and arterial stiffness, measured by pulse wave velocity, suggests its usefulness in evaluating early vascular changes linked to insulin resistance."

"However, further longitudinal studies are needed to confirm these findings and support its application in routine clinical practice," they concluded.

Reference:

Marco, M. D., Scilletta, S., Miano, N., Capuccio, S., Musmeci, M., Mauro, S. D., Filippello, A., Scamporrino, A., Bosco, G., Giacomo Barbagallo, F. D., Scicali, R., Piro, S., Purrello, F., Wagner, R., & Pino, A. D. (2025). Triglycerides to high density lipoprotein cholesterol ratio (TG/HDL), but not triglycerides and glucose product (TyG) index, is associated with arterial stiffness in prediabetes. Diabetes Research and Clinical Practice, 112189. https://doi.org/10.1016/j.diabres.2025.112189