Predictive value of non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio for clinical phenotypes of coronary heart disease and severity of coronary artery lesions

YANG Yu; JING Wei; HAN Kun; WANG Si-teng; WANG Yu-xiang; ZHANG Jing

doi:10.3969/j.issn.1672-5301.2025.11.007

Abstract：Objective To investigate the predictive value of the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio(NHHR)for coronary heart disease(CHD)and its clinical phenotypes—chronic coronary syndrome(CCS)and acute coronary syndrome(ACS),as well as its association with the severity of coronary artery lesions.Methods A total of 803 patients who underwent coronary angiography(CAG)for chest pain or tightness at the Department of Cardiology,Hefei Second People's Hospital,from January 2020 to December 2024 were retrospectively enrolled.The patients were divided into the CHD group(n=639)and the control group(n=164)based on CAG results.The CHD group was further categorized into the CCS subgroup(n=275)and the ACS subgroup(n=364).The NHHR was calculated and stratified into tertiles(Q1,Q2 and Q3 groups).The subsequent analyses were conducted to probe into the association between NHHR and CHD and its different clinical phenotypes,evaluate the diagnostic performance of NHHR and traditional lipid parameters,and explore the correlation between NHHR and the Gensini score.Finally,stratified analysis was performed to test the robustness of the observed associations.Results The CHD group had significantly higher NHHR levels compared to the control group(P<0.05).Both the prevalence of CHD and Gensini scores increased progressively with rising NHHR tertiles(all P<0.05).After the multivariate adjustment,NHHR remained the independent risk factor for CHD,with a 3.89-fold higher risk in the Q3 group compared to Q1(OR=3.89,95%CI 2.21-6.85).RCS analysis indicated a linear dose-response relationship between NHHR and CHD risk(P-overall<0.01).Notably,the association strength of NHHR with ACS(OR=4.84)was higher than that with CCS(OR=3.62)after adjustment.ROC analysis showed that NHHR had an AUC of 0.720 for CHD diagnosis,which was significantly higher than non-HDL-C(AUC=0.600)and HDL-C(AUC=0.620),and demonstrated the highest diagnostic performance for ACS(AUC=0.758).Spearman correlation demonstrated a significant positive correlation between NHHR and Gensini score in both overall coronary artery disease and its subgroups(all P<0.01).Except for a significant interaction in the hypertension subgroup(P<0.05),the association between NHHR and CHD remained consistent across the other stratified analyses.Conclusion NHHR is the independent risk factor for CHD and its clinical phenotypes,closely associated with the severity of coronary artery lesions.It exhibits superior diagnostic performance to traditional lipid parameters,particularly in differentiating ACS,suggesting its clinical value in risk stratification and diagnosis.