The effect of LDL-C/HDL-C ratio on severity of coronary artery disease and 2-year long-term prognosis in patients with premature coronary heart disease---a multicenter, observational results
Authors: Xu J , Jing C , Yingxian L , Ying S , Lin J , Shaodi Y , Wenyu G , Yi Y , Sida J , Deshan Y , Peizhi W , Jianxin L , Xueyan Z , Zhenyu L , Jinqing Y 
Published: November 2023

Abstract

Background
Low density lipoprotein cholesterol (LDL-C) level is a strong predictor of premature coronary heart disease（CHD）and a risk factor for poor prognosis. While high density lipoprotein cholesterol (HDL-C) is a protective factors for atherosclerosis. However, the relationship between the LDL/HDL ratio and the severity of coronary artery disease and the prognosis of patients with premature CHD is still unclear.

Purpose
To explore the effect of LDL-C/HDL-C ratio on the severity of coronary artery disease and 2-yeat long-term prognosis in patients with premature CHD.

Methods
This prospective, multicenter, observational cohort study is from the PROMISE study. 18701 patients with CHD were selected from January 2015 to May 2019. 3861 patients with premature CHD were enrolled in the current study. According to the median of LDL-C/HDL-C ratio (2.4), Patients were divided into two groups: low LDL-C/HDL-C group (LDL-C/HDL-C≤2.4, n=1867) and high LDL-C/HDL-C group (LDL-C/HDL-C&gt;2.4, n=1994).

Results
Compared with the low LDL-C/HDL-C ratio group, the high LDL-C/HDL-C ratio group was younger. The levels of total cholesterol, triglyceride and LDL-C in the high LDL-C/HDL-C group were significantly higher than those in the low LDL-C/HDL-C group (3.67 ± 0.85 vs 4.91 ± 1.15; 1.66 ± 1.49 vs 2.22 ± 1.45; 2.0 ± 0.57 vs 3.22 ± 0.95, respectively, all p&lt;0.001), and the HDL-C level was lower (1.17 ± 0.29 vs 0.96 ± 0.21, p&lt;0.001). The number of target lesions, the number of coronary artery lesions, the preoperative SNYTAX score and the proportion of three-vessel coronary artery disease in the high LDL-C/HDL-C group were significantly higher than those in the low LDL-C/HDL-C group (0.97 ± 0.80 vs 1.04 ± 0.74, p=0.002; 1.85 ± 0.84 vs 2.04 ± 0.84, p&lt;0.001; 11.70 ± 8.05 vs 13.81 ± 8.87, p&lt;0.001; 27.4% vs 36.2%, respectively, p&lt;0.001). Correlation analysis showed a significant positive correlation between LDL-C/HDL-C ratio and preoperative SYNTAX score, the number of coronary artery lesions, the number of target lesions and whether it was a three-vessel coronary artery disease (all p&lt;0.05). The 2-year follow-up results showed that the incidence of MACCE in the high LDL-C/HDL-C group was significantly higher than low LDL-C/HDL-C group (6.9% vs 9.1%, p=0.011). COX multivariate regression analysis showed LDL-C/HDL-C ratio has no relationship with 2-year adverse events with patients with premature CHD.

Conclusion
(1) The patients with LDL-C/HDL-C ratio higher than 2.4 may suffer from atherosclerotic cardiovascular disease earlier; (2) High LDL-C/HDL-C ratio has significantly positive correlation with the severity of coronary artery disease in patients with premature CHD. The incidence of MACCE of patients with high LDL-C/HDL-C ratio was significantly higher in 2 years follow-up; (3) LDL-C/HDL-C ratio may be a better indicator for evaluating the severity of coronary artery disease and long-term prognosis in patients with premature CHD.Comparison of coronary artery disease2-year outcomes