P0416 - Triglyceride to Direct High Density Lipoprotein Cholesterol Ratio and Risk for Elevated Systolic Blood Pressure Among Adolescent - Results from the 2005-2016 National Health and Nutrition Examination Survey

Background
The plasma concentration ratio of triglyceride to direct high-density lipoprotein cholesterol (TG/HDL-C) predicts systolic hypertension (HTN) and other cardiometabolic diseases in adults. However, the association with elevated systolic blood pressure (SBP) in adolescents has not been adequately studied. In this study, we endeavor to elucidate if an elevated plasma TG/HDL-C ratio correlates independently with systolic hypertension in adolescents by utilizing cross-sectional data from a large sample population.

Methods
Data came from the National Health and Nutrition Examination Survey (NHANES) for the period 2005-2016. Eligible subjects were adolescent aged 13 – 20 years. Elevated SBP was defined as BP ≥120mmHg. Subjects were stratified into high and low TG/HDL- based on the race-specific tertiles for lean subjects with BMI <85th percentile. The cut-off point for high and low TG/HDL-C was 1.28 for whites and 0.9 for blacks. Demographic variables and other co-variables weight, height, BMI, total cholesterol, waist circumference and fasting glucose were extracted. Mean and percentages were analyzed for significance using T-test and Chi-square. We used a multiple logistic regression model to determine the odds of elevated BP among those with high TG/HDL- c. Statistical analysis was conducted using SAS 9.4.

Result
A total of 3,657 individuals (52% males) had lab values for TG and HDL-C. The mean age at screening for elevated SBP and dyslipidemia was 16.6 ± 2.4. 42.6% of the study population had high TG/HDL-C and there were more males with high TG/HDL-C compared to females (55.4% vs 44.6%, P = 0.0004). In the unadjusted analysis, high TG/HDL-C was associated with elevated SBP (OR, 1.51: 95% CI 1.13, 2.01). However, after adjustment for sex, age, race, body mass index, waist circumference, total cholesterol and fasting glucose, the risk was not significant (OR, 1.27: 95% CI 0.88, 1.84)

Conclusion
In our cross-sectional study, the prevalence of high TG/HDL-C ratio was higher in males than females. High TG/HDL-C was not independently associated with the risk of systolic HTN in adolescents. Though TG/HDL-C has been shown to independently predict cardiometabolic conditions including HTN in adults, it does not appear to strongly correlate with presence of systolic HTN in adolescents. More studies are needed to evaluate the usefulness of this parameter, or if other metabolic or anthropometric parameters are independently useful in predicting or identifying HTN and cardiometabolic diseases in this age group. Future directions could further expand this cross-sectional study to a cohort to investigate if metabolic parameters may act as predictors for future development of hypertension and cardiometabolic disease and provide useful risk-stratification tools for clinical practice.