The Correlation between Serum TG/HDL-c ratio and Arterial Stiffness Using the Cardio- ankle Vascular Index in Overweight or Obese Patients

Background. The effect of increasing TG/HDL-c serum ratio, as a result of insulin resistance, is considered to have an important role in the occurrence of arterial stiffness. Increased arterial stiffness is an important marker in the development of cardiovascular disease and is a predictor of heart attack and stroke. Aims. This research was conducted to determine the relationship between the arterial stiffness assessed through non-invasive cardio-ankle vascular index (CAVI) examination and the TG/HDL-c ratio in overweight and obese individuals. Cardio-Ankle Vascular Index (CAVI) is a noninvasive clinical measurement to evaluate arterial stiffness manner and independent of blood pressure. Methods. This study is considered as correlational study using purposive sampling as the technique. Thirty two subjects participated in this research and each of them was subjected a CAVI examination to assess arterial stiffness. Their blood samples were collected for lipid profile measurement. The data were analyzed using Pearson Correlation Test. Results. The correlation between TG/HDL-c serum level and arterial stiffness using CardioAnkle Vascular Index (CAVI) in overweight or obese patients (p <0,01) proved to be positive and significant. Original Research The Correlation between Serum TG/HDL-c ratio and Arterial Stiffness Using the Cardioankle Vascular Index in Overweight or Obese Patients A. Oktovianto1, N. P. A. Laksmi1, R. M. Yogiarto1,2*, and J. N. E. Putranto1,2 1 Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia. 2 Department of Cardiology and Vascular Medicine, Soetomo General Hospital, Surabaya, Indonesia.


Introduction
Overweight or obesity could change the structure and function of the blood vessels that lead to an increase in the blood vessels stiffness (arterial stiffness). Arterial stiffness occurs in the early phase and contributes to the process of cardiovascular premature dysfunction [1,2]. The mechanism of arterial stiffness in overweight or obese populations involving some complex process has not been known completely. Furthermore, the last study is still controversial and advanced research is needed to clarify the factors that initiate and hasten the progression of this phenomenon.
Therefore, a deeper understanding of the mechanism of arterial stiffness in overweight/obesity has a great clinical significance [1]. In this research, we will discuss the relationship September 2020 | Vol 1 | Article 1 between the arterial stiffness assessed through non-invasive cardio-ankle vascular index (CAVI) examination and the TG/HDL-c ratio in overweight and obese individuals, to give understanding about the management [1,2].

Methods
This research used analytic correlational design.

Results
The study was done in Cardiology Clinic Dr.   showed that the proatherogenic profile lipid metabolism changes and the increase of the cardiovascular incidence are in line with the increasing of BMI [9].

c. Cardio-ankle vascular index (CAVI) number
Arterial stiffness is one of the cardiovascular morbidity and mortality predictor. A study by Luo et al., showed that there was a significant positive correlation between arterial stiffness with the risk of coronary heart disease incident [10]. The progressive structural changes, such as elastin fragmentation and degeneration, increasing of collagen, artery wall thickness, and endothelium damage cause the increase of arterial stiffness incidence.
In this study, CAVI examination was done in all subjects using VaSera VS-1000 machine. CAVI was used to assess the arterial stiffness and to evaluate the risk of cardiovascular disease incidence. From 32 subjects, there were nine subjects (28,2%) with abnormal CAVI. The increased CAVI score showed the progressivity of the arterial stiffness. However, from this data, we could not find the significant correlation between CAVI and the blood pressure, neither systolic (p=0.686) nor diastolic (p=0.408), also the correlation between CAVI with ABI (p=0.504).
These results were in line with the study by Kotani et al., which proved that the benefit of arterial stiffness measurement with CAVI depended on the stiffness-β parameter and was not influenced by blood pressure [11]. Next, the correlation between TG/ serum HDL-c ratio and arterial stiffness may be related to the increased of small dense-LDL (sd-LDL) particle, which is considered as more atherogenic than normal size LDL particle because the sd-LDL particle is easier to enter the blood vessel wall, as well as more vulnerable to oxidative modification, which in turn will be increasing its atherogenicity [12]. These findings showed that high TG/serum HDL-c ratio could be used as the clinical indicator of insulin resistance and the increasing of sd-LDL particle can be used to evaluate the early damage phase of vascular. Further study is needed to explain the right mechanism responsible for that correlation. years) CAVI was correlated significantly to the cardiovascular and myocardial infarction incidence [9]. With the data above and based on the literature, CAVI measurement can be used to evaluate the subclinical cardiovascular disease that can predict the cardiovascular incidence in the future. The correlation between obesity and CAVI is strengthened by the study that showed that weight loss in the obesity subject can improve the arterial stiffness assessed with CAVI [13]. Therefore, healthy lifestyle changes to achieve the ideal weight can decrease the cardiovascular risk. Some of the limitations in this study were its sampling technique and small scope population. Samples were taken by purposive sampling because of the time limit, number of patients, and the budget. This study conducted in a small scope of population and nonmulticentre.

Conclusion
There is a positive and meaningful correlation between TG/serum HDL-c ratio level and arterial