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Insulin Resistance Risk Ranges
• Low risk: Ratio < 2.0
• Moderate risk: Ratio 2.0–3.0
• High risk: Ratio > 3.0
Cardiovascular Risk Ranges:
(atherogenic index of plasma - AIP)
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• Low risk: Ratio < 2.0
• Moderate risk: Ratio 2.0–3.0
• High risk: Ratio > 3.0
(swipe the display vertically for results)
The triglyceride-to-HDL cholesterol (TG/HDL) ratio is a key marker for assessing insulin resistance and cardiovascular health. Here’s how it works:
Relationship to Insulin Resistance
• Elevated triglycerides and low HDL cholesterol are characteristic of insulin resistance and metabolic syndrome.
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• Insulin resistance impairs the body’s ability to process fats efficiently, leading to increased triglyceride production in the liver and reduced HDL levels.
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• A higher TG/HDL ratio suggests poorer metabolic health and a higher likelihood of insulin resistance.
Clinical Significance of TG/HDL Ratio
Low ratio (<2 in mg/dL units, or <0.9 in mmol/L):
• Indicates better insulin sensitivity.
• Associated with a healthier lipid profile and lower cardiovascular risk.
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High ratio (>3.5 in mg/dL units, or >1.5 in mmol/L):
• Strongly correlated with insulin resistance.
• Often seen in individuals with prediabetes, type 2 diabetes, or metabolic syndrome.
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Impact of a Low-Carb or Ketogenic Diet
For individuals on a ketogenic or low-carb diet:
• Triglycerides typically decrease due to reduced carbohydrate intake and improved fat metabolism.​
• HDL cholesterol often increases with dietary fat intake and weight loss.​
• This combination can significantly improve the TG/HDL ratio, enhancing insulin sensitivity and reducing cardiovascular risk.
Atherogenic Index of Plasma (AIP) Overview:
The Atherogenic Index of Plasma (AIP) is a logarithmic calculation used to assess the balance between triglycerides (TG) and high-density lipoprotein cholesterol (HDL-C).​​​​​​
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It’s a simple, inexpensive measure that indirectly reflects lipoprotein particle size:
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• Higher TG/HDL ratios correlate with smaller, dense LDL particles, which are more atherogenic.
• Lower ratios are linked to larger, buoyant LDL particles, which are less harmful.
• TG/HDL ratio is also a predictor of atherosclerosis and cardiovascular disease (CVD).
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Relation to Particle Size:
Small Dense LDL (sdLDL):
A high AIP indicates an unfavorable lipid profile characterized by an increase in small, dense low-density lipoproteins (sdLDL). These particles are more atherogenic compared to large LDL particles because:
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• They penetrate the arterial wall more easily.
• They are more susceptible to oxidation, a key step in plaque formation.
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HDL Particle Functionality:
Low HDL levels, which contribute to a higher AIP, often correlate with dysfunctional HDL particles that are less effective at reverse cholesterol transport.
Cardiovascular Risk Implications:
1. High AIP Values:
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• Associated with increased cardiovascular disease (CVD) risk due to the dominance of sdLDL and reduced protective HDL functionality.
• Indicates poor lipid metabolism and insulin resistance.
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2. Low AIP Values:
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• Suggest a healthy balance of lipid particles, with a predominance of larger, less dense LDL particles and functional HDL.
3. Clinical Relevance:
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• AIP is considered more sensitive than individual triglyceride or HDL measurements because it reflects the interplay between pro-atherogenic and anti-atherogenic lipids.
• AIP can predict the likelihood of metabolic syndrome, type 2 diabetes, and coronary artery disease (CAD).
Why Particle Size Matters:
• Large LDL Particles: Less likely to penetrate the arterial wall and initiate atherosclerosis.
• Small Dense LDL Particles: More prone to:
• Arterial wall penetration.
• Oxidative modification.
• Triggering inflammatory responses leading to plaque formation.
Summary:
The AIP is a powerful, easy-to-calculate index for assessing cardiovascular risk. By linking triglyceride levels with HDL cholesterol, it reflects the quality and functionality of lipoproteins, highlighting the role of sdLDL and HDL in atherogenesis. A higher AIP signals an urgent need for lifestyle and possibly pharmacological interventions to reduce cardiovascular risk.
