Changes of serum LDL-C/HDL-C ratio and Lp(a)in patients with type 2 diabetes and coronary heart disease and their correlation with major adverse cardiovascular events in the near future after PCI

Yin Jiafeng; Song Linlan; Dong Wei; Zhang Ni; Han Jie; He Qian

doi:10.3969/j.issn.1671-6450.2025.03.002

Abstract：Objective To investigate the changes of serum low density lipoprotein cholesterol(LDL-C)/high densi-ty lipoprotein cholesterol(HDL-C)ratio,lipoprotein(a)[Lp(a)]in patients with type 2 diabetes mellitus(T2DM)and coro-nary heart disease(CHD)and their correlation with major adverse cardiovascular events(MACE)in the near future after per-cutaneous coronary intervention(PCI).Methods A total of 120 T2DM patients with CHD admitted to the Second Affilia-ted Hospital of Xi'an Jiaotong University from September 2022 to June 2023 were selected as the observation group,and 65 patients with CHD alone were selected as the control group.According to whether MACE occurred recently after PCI,T2DM patients with CHD were divided into poor prognosis subgroup(29 cases)and good prognosis subgroup(91 cases).Serum LDL-C and HDL-C levels were determined by enzymatic method,and serum Lp(a)levels were determined by immu-noturbidimetry.The correlation between serum LDL-C/HDL-C ratio,Lp(a)level and Gensini score was analyzed by Pearson method.Multivariate Logistic regression analysis was performed to analyze the influencing factors of MACE in T2DM pa-tients with CHD after PCI.The predictive value of serum LDL-C/HDL-C ratio and Lp(a)level for short-term MACE in T2DM patients with CHD after PCI was analyzed by receiver operating characteristic(ROC)curve.Results The LDL-C/HDL-C ra-tio and Lp(a)level in the observation group were higher than those in the control group(t/P=6.594/＜0.001,11.369/＜0.001).The results of Pearson analysis showed that the serum LDL-C/HDL-C ratio and Lp(a)level in T2DM patients with CHD were positively correlated with Gensini score(r/P=0.751/＜0.001,0.744/＜0.001).At 12 months follow-up after PCI,the incidence of MACE in 120 T2DM patients with CHD was 24.17％(29/120).Gensini score,serum LDL-C/HDL-C ratio and Lp(a)level in poor prognosis subgroup were higher than those in good prognosis subgroup(t/P=3.939/＜0.001,4.413/＜0.001,4.333/＜0.001).Multivariate Logistic regression analysis showed that high Gensini score,high LDL-C/HDL-C ratio,and high serum Lp(a)level were independent risk factors for MACE in patients with T2DM combined with CHD after PCI[OR(95％CI)=5.298(3.259-8.614).4.817(2.914-7.963),4.855(2.852-8.264)];The area under the curve(AUC)of serum LDL-C/HDL-C ratio,Lp(a)level and their combined prediction of near-term MACE after PCI in T2DM patients with CHD were 0.765,0.737 and 0.930,respectively.The combined AUC was greater than that predicted by serum LDL-C/HDL-C ratio and Lp(a)level alone(Z/P=20.093/0.000,18.651/0.000).Conclusion LDL-C/HDL-C ratio and serum Lp(a)level are abnormally high in T2DM patients with CHD,and are positively correlated with Gensini score,respectively.The combination of the two can effectively predict the near-term risk of MACE in T2DM patients with CHD after PCI.