A study of the predictive value of non-high-density lipoprotein cholesterol and remnant lipoprotein cholesterol in acute myocardial infarction

WU Li-li; REN Peng; ZHANG Bao-zhi; WANG Shan

doi:10.3969/j.issn.1672-5301.2025.07.004

Abstract：Objective The differences in serum concentrations of non-high-density lipoprotein cholesterol(non-HDL-C)and remnant lipoprotein cholesterol(RLP-C)in patients with acute myocardial infarction(AMI)and other patients with coronary atherosclerotic heart disease were compared and analyzed,and the predictive value of the two for the first occurrence of AMI and its diagnostic cut-off value were discussed.Methods Patients admitted to the Department of Cardiology of the 901st Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army from November 2021 to March 2024 were selected.178 study subjects were screened according to the inclusion and exclusion criteria,and were divided into AMI group(66 cases)and non-AMI group(112 cases)according to whether AMI occurred;According to their age,they were divided into the elderly group(82 cases)and the non-elderly group(96 cases)According to the type of chronic disease,the patients were divided into diabetes group(48 cases),non-diabetes group(138 cases),hypertension group(109 cases),and non-hypertension group(69 cases).The general clinical data and routine blood lipid indexes of the patients were collected,and non-HDL-C and RLP-C were calculated by formula.Correlation analysis was used to analyze the correlation between non-HDL-C、RLP-C and conventional blood lipid indexes.Univariate and multivariate Logistic regression analysis were used to explore the independent risk factors of AMI.Then Subgroup analyses were performed.The receiver operating characteristic curve(ROC curve)was plotted to evaluate the predictive value of non-HDL-C and RLP-C in the initial dose of AMI,compared with the traditional predictive ability of blood lipid indicators,and the optimal diagnostic cut-off value was found.Results Non-HDL-C was strongly correlated with total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C)and apolipoprotein B(ApoB)(r values were 0.947,0.869 and 0.909,respectively,all P<0.001).RLP-C was strongly correlated with non-HDL-C and total triglyceride(TG)(r values were 0.619 and 0.653,all P<0.001),and RLP-C was moderately correlated with TC and ApoB(r values were 0.502 and 0.480,all P<0.001).There were significant differences in the proportion of male patients,serum concentrations of TG,TC,LDL-C,ApoB,non-HDL-C,RLP-C,high-density lipoprotein cholesterol(HDL-C)and apolipoprotein A1(ApoA1)between the two groups(P<0.05).Univariate and multivariate Logistic regression analysis showed that non-HDL-C≥3.12 mmol/L(OR=2.790,95%CI 1.168-6.664)and RLP-C≥0.61 mmol/L(OR=11.524,95%CI 4.233-31.373)were independent risk factors for the first onset of AMI.Among them,RLP-C≥0.61 mmol/L was significantly higher in the elderly group(OR=5.930,95%CI 1.528-23.019),non-elderly group(OR=10.029,95%CI 3.167-31.758),diabetes group(OR=11.454,95%CI 1.201-29.254),non-diabetic group(OR=8.598,95%CI 3.228-22.900),and hypertension group(OR=7.076,95%CI 2.514-19.915)and non-hypertensive groups(OR=9.528,95%CI 2.350-38.627)were still independent risk factors for AMI(P<0.05);Non-HDL-C≥3.12 mmol/L remained an independent risk<factor for AMI in the elderly group(OR=3.515,95%CI 1.158-10.668),non-elderly group(OR=2.116,95%CI 1.678-6.601),and hypertension group(OR=6.713,95%CI 2.108-21.373).The results of ROC curve showed that the area under the curve(AUC)of non-HDL-C in predicting the occurrence of AMI was 0.747,95%CI(0.673-0.821),the optimal cut-off value was 3.115 mmol/L,the sensitivity was 0.742,and the specificity was 0.670.The AUC of RLP-C was 0.792,95%CI(0.728-0.857),the optimal cut-off value was 0.605 mmol/L,the sensitivity was 0.879,and the specificity was 0.643.Non-HDL-C and RLP-C had similar ability to predict the occurrence of AMI(P>0.05),which were better than the traditional blood lipid indexes TG,TC,HDL-C,and LDL-c(P<0.05).Conclusions Serum non-HDL-C≥3.12 mmol/L and RLP-C≥0.61 mmol/L were independent risk factors for the first episode of AMI in adults,and they had certain predictive value in the clinical diagnosis of the first episode of AMI,and the two are better than traditional blood lipid indicators.