Thread by @PreKureOfficial

Low TG-high HDL-C and risk of ischemic heart disease.
2001, n=2906, male subjects.
"Men with conventional risk factors for IHD have a low risk of IHD if they have low TG/HDL-C ratio."
There are some interesting stats hidden here: 1/n
jamanetwork.com/journals/jamai…

47% of the low TG/HDL group were smokers, compared with 57% in both the other categories (see table 1), but alcohol intake was higher (20 vs 16 drinks/week)

36% of the low TG/HDL group reported low physical activity (=<4hr/wk), compared with 47% and 58% in the other categories. 3/n

Only 9% of men in the low TG/HDL group had hypertension, compared with 10% and 21% in the other groups. 4/n

34.28% of men in the low TG/HDL group had LDL-C >4.40 mmol/L 5/n

Here's a table attributing risk to all of these factors: LDL-C is not significant, TG/HDL is huge (0.6), even bearing in mind this compares with BOTH of the other groups not just the highest. 6/n

Here's something that helps explain this - genes that lower TGs, and genes that lower LDL, are equally protective against IHD,
But genes that lower LDL-C also lower TGs, while genes that lower TGs raise LDL-C.
This makes LDL-C a Janus-faced marker. 7/n
jamanetwork.com/journals/jama/…

Another question is why no factor was completely protective - non-smoking, active, low BP men with low TG/HDL presumably still had some heart attacks.
Biomarker studies are snapshots, Regression dilution means that factors will change in some over time. 8/n

This is the 2-faced Roman God Janus. If LDL-C can be elevated by protective genetics (or practices) and harmful ones, it is a Janus-faced maker, and we will always need (fasting) TG/HDL to show us which face we are seeing. 9/n