Year: 2025 | Month: May | Volume: 12 | Issue: 5 | Pages: 404-421
DOI: https://doi.org/10.52403/ijrr.20250542
Lipid and Inflammatory Biomarkers in HFrEF: A Comprehensive Review of TG/HDL, MHR, and Dapagliflozin Therapy
Asli Elmi Hassan1, Yuan Xiaochen1
Department of Cardiology, Clinical Medical College of Yangzhou University (Affiliated Hospital of Yangzhou University), Yangzhou, Jiangsu Province, China.
Corresponding Author: Yuan Xiaochen
ABSTRACT
Heart failure with reduced ejection fraction (HFrEF) >is a complex clinical syndrome driven by a combination of hemodynamic, metabolic, and inflammatory disturbances. Increasing attention has been directed toward lipid-related and inflammatory biomarkers such as the triglyceride-to-HDL cholesterol (TG/HDL) ratio >and monocyte-to-HDL ratio (MHR), which offer insights into cardiovascular risk, metabolic dysfunction>, and systemic inflammation. This review explores the pathophysiological relevance of TG/HDL and MHR in HFrEF, their prognostic utility, and how pharmacologic agents—particularly sodium-glucose cotransporter-2 (SGLT2) inhibitors like dapagliflozin—modulate these biomarkers to improve patient outcomes (1). Current evidence suggests that integrating TG/HDL and MHR into clinical assessment may enable better risk stratification, therapeutic monitoring, and personalization of heart failure management.
Methods: A comprehensive search of electronic databases including PubMed, MEDLINE, and Google Scholar was conducted using relevant keywords, Heart failure with reduced ejection fraction (HFrEF), sodium-glucose cotransporter-2 (SGLT2) inhibitors, metabolic dysfunction, systemic inflammation,
the triglyceride-to-HDL cholesterol (TG/HDL) ratio and MHR in HFrEF.
Articles published in English between [2010] and [2024] were considered for inclusion. Studies investigating the relationship between Heart Failure with Reduced Ejection Fraction (HFrEF) in TG/HDL and MHR in Dapagliflozin Therapy.
Results: An extensive review of studies from 2010 to 2024 demonstrated that both TG/HDL and MHR are significant biomarkers in HFrEF, reflecting underlying metabolic dysfunction and systemic inflammation. Elevated TG/HDL was consistently associated with insulin resistance, adverse lipid profiles, and worse cardiovascular outcomes, while high MHR correlated with increased monocyte activity, oxidative stress, and poor prognosis. Dapagliflozin therapy was found to improve TG/HDL by lowering triglyceride levels and raising HDL cholesterol and to reduce MHR by decreasing monocyte activation and systemic inflammation. These effects corresponded with improved endothelial function, reduced atherosclerotic burden, and enhanced clinical outcomes in HFrEF patients.
Keywords: Heart failure, HFrEF, TG/HDL, MHR, dapagliflozin, inflammation, insulin resistance, biomarkers, cardiovascular risk, SGLT2 inhibitors
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