TG/HDL Ratio: A Major Marker and Potent Predictor of Coronary Heart Disease


The TG/HDL Ratio as a Marker of Coronary Heart Disease

A Harvard study published October 21, 1997 in the Journal Circulation stated that

“High triglycerides alone increased the risk of heart attack nearly three-fold.  People with the highest ratio of triglycerides to HDL, had 16 times the risk of heart attack as those with the lowest ratio of triglycerides to HDL in the study of 340 heart attack patients and 340 of their healthy, same age counterparts.”  1 

This Harvard study was the first to report in a case control study that the TG/HDL (triglycerides/HDL cholesterol) ratio strongly predicted risk of myocardial infarction.

Since this study in 1997, other researchers have linked a high TG/HDL-C ratio to: 

  • coronary atherosclerosis  2  3
  • impaired heart rate recovery after exercise  4
  • Coronary Heart Disease (CHD) incidence  5 
  • cardiovascular disease and all cause death  6

The TG/HDL ratio has been widely proposed as an atherogenic marker 7, and a high TG/HDL ratio correlates with LDL phenotype B, small HDL particles, and insulin resistance.  8  9 

Dr. Barry Sears has stated in many of his publications that the TG/HDL ratio is a marker of insulin resistance in the liver.  If that ratio is greater than 2, the patient is heading toward pre-diabetes.  10


A triglyceride is an ester derived from glycerol and three fatty acids and are the main constituents of body fat in humans.

The National Cholesterol Education Program has set guidelines for triglyceride levels:   11

Level Interpretation
(mg/dL) (mmol/L)
< 150 < 1.70 Normal range – low risk
150–199 1.70–2.25 Slightly above normal
200–499 2.26–5.65 Some risk
500 or higher > 5.65 Very high – high

High-density lipoproteins (HDL)

High-density lipoproteins (HDL) are one of the five major groups of lipoproteins. Lipoproteins are complex particles composed of multiple proteins which transport all fat molecules (lipids) around the body within the water outside cells (extracellular matrix).

The function of HDL particles is to remove fat molecules from cells which need to export fat molecules.  This is often why HDL is termed the “good” cholesterol.

The American Heart Association, National Institutes of Health and the National Cholesterol Education Program provides a set of guidelines for fasting HDL levels and risk for heart disease.  12

Level mg/dL Level mmol/L Interpretation
<40 for men, <50 for women <1.03 Low HDL cholesterol, heightened risk for heart
40–59 1.03–1.55 Medium HDL level
>60 >1.55 High HDL level, optimal condition considered
protective against heart disease

Calculating the TG/HDL ratio

The TG/HDL ratio is not a separate blood test that can be administered.  An individual needs to determine their TG levels and HDL levels in a comprehensive lipid profile blood test and then calculate the TG/HDL ratio from these two results.

The two lipid levels, TG and HDL are expressed differently depending on the country in which the test is administered.

If tested in the United States, then lipid values are expressed as mg/dl

If tested in Australia, Canada, and Europe, then lipid values are expressed as mmol/L

The ideal TG/HDL ratio should be:

  • 1 or less (using mg/dl) 
  • 0.4 or less (using mmol/ml)

If lipid values are expressed as mg/dl (United States):

  • TG/HDL ratio less than 2 is ideal
  • TG/HDL ratio above 4 is too high
  • TG/HDL ratio above 6 is excessive

If lipid values are expressed as mmol/L (Australia, Canada, and Europe):

  • TG/HDL ratio less than 0.87 is ideal
  • TG/HDL ratio above 1.74 is too high
  • TG/HDL ratio above 2.62 is excessive

According to Dr. Barry Sears, the following Table can be used as a guide to determine where your health status falls based on your TG/HDL ratio:

Test (mg/dl) Diseased: Already have a chronic disease Poor: On a path to chronic disease Good: On the path to wellness Ideal: State of Wellness
TG/HDL 4 or greater 3 2 1

How to Lower a High or Less than Ideal TG/HDL Ratio

If the TG/HDL ratio is greater than the ideal range, this would indicate that insulin resistance is beginning to appear in the liver and that a more strict anti-inflammatory diet is required to reduce the cellular inflammation that causes such insulin resistance.  13

There are a few accepted ways to lower triglyceriedes and increase HDL cholesterol levels:

Increase intake of omega-3 fatty acids in the form of EPA and DHA (fish oil)  (lowers triglyceriedes)

Take Niacin (Vitamin B3)

Supplement with Citrus Bergamot (Bergamonte®):  14

Information provided by HP Ingredients, exclusive producers of Bergamonte®

Bergamot (Citrus Bergamia Risso) is a citrus plant that grows almost exclusively in the narrow coastal Calabria region in Southern Italy, due to sensitivity to the weather and soil conditions. Bergamot juice was traditionally recognized by the local population as a remedy for supporting healthy cholesterol level and cardiovascular health. The medicinal use of bergamot, forgotten for decades, is now being rediscovered.

The juice and albedo of bergamot has a unique profile of flavonoid and glycosides, such as neoeriocitrin, neohesperidin, naringin, rutin, neodesmin, rhoifolin and poncirin. Naringin have been shown to be beneficial in animal models of atherosclerosis, while neoeriocitrin and rutin have been found to exhibit a strong capacity to prevent LDL from oxidation. Importantly, bergamot juice is rich in brutieridine and melitidine with an ability to inhibit HMG-CoA reductase.

Figure 1.  Bergamot (Citrus Bergamia Risso) (Source)

Standardized, Clinically Tested

Bergamonte® contains bioactive compounds of extract of the juice and albedo of citrus bergamia risso, standardized to > 30% polyphenolic flavanoids consisting of Naringin, Neohesperidin, Neoeriocitrin, 1% Melitidine, and 2% Brutelidine. Bergamonte® is produced using patented extraction technology through collaborative works of various Universities and research institutions in Italy. These flavanoids are clinically proven to help maintain healthy cholesterol level, healthy blood glucose level, increase HDL-cholesterol, and promoting healthy weight management.

Benefits of Bergamonte®

  • Cardiovascular Health
  • Supports Healthy Cholesterol
  • Supports Healthy Blood Sugar
  • Healthy Weight Loss

Citrus Bergamot Differs From C. Aurantium…

Citrus Bergamot differs from C. Aurantium as Citrus Bergamot does not contain Synepherine, N-methyltyramine, and octopamine, which have been shown in research to constrict arteries, increase blood pressure, increase heart rate, cause
heart-rhythm disorders, heart attack, and stroke.

Citrus Bergamot contains Melitidine and Brutelidine which is absent in C. Aurantuim. Research has shown that these compounds significantly reduce total cholesterol, LDL, Triglycerides, blood glucose levels, while increasing HDL.

Melitidine and Brutieridine
A published research article in the Journal of Natural Products 2009 showed that bergamot juice contained novel compounds with statin like principles, having the 3-hydroxy3-methylglutaric acid (HMG) found to the naringin (melitidine) and neohesperidin (brutieridine).

These novel compounds interfere with the natural synthesis of the cholesterol pathway in the human body: The HMG-CoA substrate interferes with the synthesis of the mevalonate acid, blocking the cholesterol production.

Mode of Action

  • Inhibiting HMG-CoA Reductase
  • Inhibiting Phosphodiesterases PDEs
  • ‘Activating’ AMPK

Efficacy Findings from Clinical Trials

In an unpublished human clinical trial involving 192 patients, the following are the result after patients consumed 100ml of Citrus Bergamot juice for 30 days.

Hypolipemic and Hypoglycemic Activity of Bergamot Polyphenolic Fraction

Fitoterapia 82 (Nov 2011) 309–316
237 patients with hyperlipemia, hypercholesterolemic (HC, cLDL, low cHDL), mixed dyslipidemic (HC and TG), or metabolic syndrome (HC, HT, and HG) were taking either placebo, 500mg, 1000mg.

Supports healthy cholesterol level, increase LOX-1 expression and Protein Kinase B phosphorylation  ( Already within the normal range)

International Journal of Cardiology, 2013
In this open-label, parallel group, placebo-controlled study, 77 patients were randomly assigned either placebo, Rosuvastatin, Bergamot Polyphenolic Fraction or combination of Bergamot Polyphenolic Fraction with Rosuvastatin for 30 days.

Both doses of rosuvastatin and Bergamot Polyphenolic Fraction help support healthy cholesterol level and reduce urinary mevalonate compared to control group. The benefits are associated with significant reductions of biomarkers used for detecting oxidative vascular damage, including malondialdehyde, oxyLDL receptor LOX-1 and phosphoPKB.

Effects on LDL Small Dense Particles, Metabolic Biomarkers, and Liver Function

Advances in Biological Chemistry, 2014, 4, 129-137
107 patients with metabolic syndrome and non fatty liver disease were given either placebo or 650 mg of Bergamot Polyphenolic Fraction twice a day for 120 days. Bergamot Polyphenolic Fraction group showed significant reduction in fasting plasma glucose, rotal cholesterol, LDL cholesterol, triglycerides, and increase of HDL cholesterol. Bergamot Polyphenolic Fraction decrease IDL particles by 51%, increase large LDL by 38%, decrease small LDL by 35%, and 20% increase of total HDL particles. Hepatorenal index was significantly reduced by 46%, accompanied by reduction of hepatic ultrosonographic pattern of steatosis by 99%. This suggests Bergamot Polyphenolic Fraction improves both liver function and inflammation as confirmed by reduction of TNF-α and CRP.

Product Comparison

Bergamonte® is an exclusive product of HP Ingredients

References for Bergamonte®
  1. Ross Walker, Elzbieta Janda and Vincenzo Mollace. The Use of Bergamot-derived Polyphenol Fraction in Cardiometabolic Risk Prevention and its Possible Mechanisms of Action. Cardiac Health and Polyphenols. Chp 84, Pg 1085-1103, 2014
  2. Micaela Gliozzi, Ross Walker, Elzbjeta Janda, Vincenzo Mollace. Bergamot polyphenolic fraction enhances rosuvastatin-induced effect on LDLcholesterol, LOX-1 expression and Protein Kinase B phosphorylation in patients with hyperlipidemia. International Journal of Cardiology Dec 2013, 170(2):140-5
  3. Vincenzo Mollace, Iolanda Sacco, Elzbieta Janda, Claudio Malara, Domenica Ventrice, Carmen Colica, Valeria Visalli, Saverio Muscoli. Hypolipemic and hypoglycaemic activity of bergamot polyphenols: From animal models to human studies. Fitoterapia 82 (2011) 309–316
  4. Celia C, Trapasso E, Locatelli M, Navarra M, Ventura CA, Wolfram J, Carafa M, Morittu VM, Britti D, Di Marzio L.. Anticancer activity of liposomal bergamot essential oil (BEO) on human neuroblastoma cells. Colloids Surf B Biointerfaces. 2013 Dec 1;112:548-53
  5. Delle Monache S, Sanità P, Trapasso E, Ursino MR, Dugo P, Russo M, Ferlazzo N, Calapai G, Angelucci A, Navarra M. Mechanisms underlying the anti-tumoral effects of Citrus Bergamia juice. PLoS One. 2013 Apr 16;8(4)
  6. Kang P, Suh SH, Min SS, Seol GH. The essential oil of Citrus bergamia Risso induces vasorelaxation of the mouse aorta by activating K(+) channels and inhibiting Ca(2+) influx. J Pharm Pharmacol. 2013 May;65(5):745-9
  7. Leopoldini M, Malaj N, Toscano M, Sindona G, Russo N. On the inhibitor effects of bergamot juice flavonoids binding to the 3-hydroxy-3-methylglutaryl-CoA reductase (HMGR) enzyme. J Agric Food Chem. 2010 Oct 13;58(19):10768-73
  8. Di Donna L, De Luca G, Mazzotti F, Napoli A, Salerno R, Taverna D, Sindona G. Statin-like principles of bergamot fruit (Citrus bergamia): isolation of 3-hydroxymethylglutaryl flavonoid glycosides. J Nat Prod. 2009 Jul;72(7):1352-4
  9. Mollace V, Ragusa S, Sacco I, Muscoli C, Sculco F, Visalli V, Palma E. The protective effect of bergamot oil extract on lecitine-like oxyLDL receptor-1 expression in balloon injury-related neointima formation. J Cardiovasc Pharmacol Ther. 2008 Jun;13(2):120-9
  10. Natalizia Miceli, Maria Mondello, Maria Mondorte, Vasileios Sdrafkakis, Paola Dugo, Maria Crupi. Hypolipidemic effects of bergamot juice in rats Fed a Hypercholesterolemic Diet. J. Agric. Food Chem., Vol. 55, No. 26, 2007