The LDL-C/HDL-C ratio and 4-year risk of coronary artery disease: a retrospective study
Authors: zhang shaohui , Zhao Yongliang , Li Xiangting , Dai Wen , Chen Xueying , Yang Guoliang , Liu Lixin , Su Qiang 
Published: March 2020

Abstract
BackgroundNumerous studies have demonstrated that the low-density lipoprotein cholesterol/high-density lipoprotein cholesterol (LDL-C/HDL-C) ratio can reflect the positive correlation index LDL-C and the negative index HDL-C of coronary artery disease (CAD) at the same time, which is increasingly considered as a novel marker to evaluate the risk of CAD. However, whether the short-term evaluation effect of the LDL-C/HDL-C ratio can be maintained during long-term follow-up is unclear. In addition, it is not clear whether the value of LDL-C/HDL-C ratio in the risk assessment of major adverse cardiac events (MACE) varies with different treatments. Our aim of the study was to investigate the link between LDL-C/HDL-C ratio and long-term risk of CAD and find out whether the LDL-C/HDL-C ratio could effectively evaluate the occurrence of MACE in CAD patients under different treatments. MethodsFrom May 2013 to November 2015, a total of 2409 patients who underwent coronary angiography (CAG) with or without revascularization therapy were enrolled in this study. They were divided into two groups based on the LDL-C/HDL-C ratio and three groups based on the treatments: medical therapy alone (MTA), percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG).ResultsIn total, 1784 patients (74.1%) were followed for health outcome and 625 patients (25.9%) experienced a MACE event. The median follow-up time was 4.27 years (1560 days). The patients with a higher LDL-C/HDL-C ratio (≥ 2.33) also had a significantly higher incidence of MACE (HR: 1.47, 95% CI: 1.25 to 1.72, p < 0.001). The cumulative incidence of rehospitalization for UA (HR: 1.53, 95% CI: 1.27 to 1.84, p < 0.001) and rehospitalization for HF (HR: 3.70, 95% CI: 1.22 to 22.25, p = 0.021) were significantly higher in high group than in low group. There were no significant differences in MI (HR: 1.25, 95% CI: 0.63 to 2.48, P = 0.521), TLR (HR: 0.98, 95% CI: 0.62 to 1.55, p = 0.947), Stroke (HR: 1.65, 95% CI: 0.64 to 4.25, p = 0.301) and 4-year all-cause death (HR: 1.45, 95% CI: 0.58 to 3.61, p = 0.423). Kaplan-Meier cumulative curve showed that patients with higher LDL-C/HDL-C ratio had a significantly lower MACE-free survival (p < 0.001). Multivariate Cox regression analysis demonstrated that LDL-C/HDL-C ratio (HR: 1.34, 95% CI: 1.14 to 1.60, p < 0.001) together with age, smoking, hypertension, diabetes mellitus, Syntax score and TG were independent predictors of 4-year MACE in the total CAD population (all p < 0.05). Further subgroup analysis showed that age, smoking, Syntax score, TG and LDL-C/HDL-C ratio were the independent predictors of MACE in MAT group (all p < 0.05); However, Syntax score and diabetes mellitus were the only independent predictor of MACE in PCI group and the CABG group, respectively (both p < 0.05). ConclusionsIn this study, we found that LDL-C/HDL-C ratio was an independent predictor of 4-year MACE in the total CAD population. The value of LDL-C/HDL-C ratio in assessing MACE risk varied among CAD patients with different treatments.