Can Triglycerides-HDL-C Ratio, HOMA-IR, ApoB, Non-HDL Cholesterol, and Free Cholesterol be Laboratory-Associated Flags of Female Coronary Atherosclerosis Regardless of Being Diabetic?

Leonor Fernandes Teixeira1
, Nadielle Silva Bidu2
, Alysson Luiz Mendes da Silva2
, Gildásio Carvalho da Conceição3
, Daniele Brustolim2
, Roque Aras Junior4
, Ricardo David Couto2, 5, *

1 Department of Health Science, Medicine Course (Endocrinology), State University of Bahia/UNEB, Salvador, Bahia, Brazil
2 Clinical Biochemistry Laboratory, Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Bahia/UFBA, Salvador, Bahia, Brazil
3 Associação de Pais e Amigos dos Excepcionais de Salvador (APAE-Salvador), Federal University of Bahia, Salvador, Bahia, Brazil
4 Internal Medicine Department (Cardiology), Faculty of Medicine, Federal University of Bahia/UFBA, Salvador, Bahia, Brazil
5 School of Medicine, Centro Universitário de Tecnologia e Ciências (UniFTC), Salvador, Brazil

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© 2024 The Author(s). Published by Bentham Open.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Clinical Biochemistry Laboratory, Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Bahia/UFBA, University Campus, Barão de Jeremoabo street, Ondina, Salvador, Bahia, Brazil; Postal Code: 40170-115; Tel/Fax: (+5571) 3283-6952/6900; E-mail:



The study aimed to evaluate biomarkers, ratios, and indexes as flags of coronary obstructions in women with established coronary atherosclerotic disease regardless of diabetes.


A cross-sectional study was conducted on 42 confirmed atherosclerotic coronary female patients, stratified into diabetic or not and scheduled for angioplasty or coronary graft bypass surgery. Blood samples were collected immediately before coronary intervention for laboratory determinations, such as glycemia, HbA1c, insulin, HDL-C, PON-1, free cholesterol, LDL-C, Apo A-1, Apo B, and TG.


In diabetic patients, insulin was positively correlated with triglycerides (p < 0.0108; r = 0.2009), apo B (p < 0.0006; r = 0.3737), non-HDL cholesterol (p < 0.0084; r = 0.2156), and free cholesterol (p < 0.0084; r = 0.3251). Applying a linear regression model, insulin from diabetic patients showed an association with glycemia, triglycerides, and HOMA-IR (p < 0.001, R2 = 0.9868), but in non-diabetics, the association was only found between insulin and HOMA-IR (p = 0.002, R2 = 0.9031). On the other hand, using triglycerides as a dependent variable, its association has been found in both groups, but only with HOMA-IR (diabetics: p = 0.006, R2 = 0.2504; non-diabetics: p = 0.014, R2 = 0.4697). Also, the TG/HDL-C ratio was higher than 2.5 in 90% of diabetics and 83.33% of non-diabetic patients.


The high prevalence of females with a TG/HDL-C ratio above 2.5, the association among insulin, HOMA-IR, and TG/HDL-C, and correlations with apoB, non-HDL-C, and free cholesterol, should be evaluated as flags of female precocious coronary atherosclerosis.

Keywords: TG/HDL-C, Insulin, HOMA-IR, Diabetes, Precocious atherosclerosis, Cholestrol.