Background: A high serum TG/HDL-C ratio has been determined to be a cardiovascular disease (CVD) and mortality risk factor.

Aim: ACS individuals' Triglycerides/High Density Lipoprotein-Cholesterol Ratio will be measured as a potential new measure of atherosclerosis.

Methods: This cross sectional trial included 200 cases with ACS. All participants subjected to full history taking, clinical assessment, laboratory investigations (CK-MB), high-sensitive cardiac troponin (hs-cTn), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), Blood urea level, serum creatinine & (eGFR), Electrocardiogram (ECG) & Echocardiography. Depending on the values of the lipid profile TGs/HDL-C ratio will be calculated.

Results: This study included 200 patients. Participants were separated into 3 groups: (Group A: n= 24 "12%", cases with unstable angina; Group B: n=124 "62%", patients with STEMI and Group C: n= 52 "26%", patients with NSTEMI). Regarding TG/HDL-C ratio, it ranged from 1.1 to 33 with mean (±SD) was 4.44± 3.26. Most cases (85.5%) had high ratio. By comparing TG /HDL ratio related to diagnosis. It was noticed non-significant differences between NSTEMI, STEMI and UA regarding TG /HDL-c ratio (p>0.05)

Conclusion: There was a strong connection among a raised Triglycerides/High Density Lipoprotein-Cholesterol Ratio & the existence of high risk atheromatous plaques in individuals with ACS. Therefore, the ratio of TG to HDL-C may be a candidate for use as a biomarker in determining the presence of atherosclerosis in patients diagnosed with Acute Coronary Syndrome.