Correlation And Predictive Value Of Unconventional Lipid Parameters With Coronary Heart Disease

Objective:To investigate the correlation and predictive value of unconventional lipid parameters in coronary atherosclerotic heart disease(CHD).Methods:A total of 174 patients with chest pain admitted to the Department of Cardiology of the Second Hospital of Shanxi Medical University from November 2021 to November2022 were selected and divided into a non CHD group of 54 patients and a CHD group of120 patients based on coronary angiography(CAG)results.According to the Gensini score,the CHD group was divided into three groups,including 40 patients with mild coronary artery disease(≤15 points),41 patients with moderate coronary artery disease(15-39 points),and 39 patients with severe coronary artery disease(>39 points).Medical history data such as sex,age,body mass index(BMI),smoking status,whether combined with hypertension,diabetes,and atrial fibrillation(AF)were collected.Platelet count(PLT),neutrophil absolute value(NEU),lymphocyte absolute value(LYM),monocyte absolute value(MON),fasting blood glucose(FPG),serum creatinine(Cr),serum potassium(K~+),serum sodium(Na~+),total cholesterol(TC),triglyceride(TG),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C)and other biochemical indicators,as well as cardiac ultrasound indicators such as left ventricular ejection fraction(LVEF)were collected.The EPI formula was used to estimate glomerular filtration rate(e GFR)for sex,age,and Cr.Unconventional lipid parameters were calculated:TG/HDL-C,triglyceride glucose product index(TyG index),TC/HDL-C,non-HDL-C,non-HDL-C/HDL-C,LDL-C/HDL-C,residual cholesterol(RC),RC/HDL-C,insulin resistance metabolic score(METS-IR).Inflammatory indicators were calculated:neutrophil to lymphocyte ratio(NLR),monocyte to lymphocyte ratio(MLR),systemic immune inflammatory index(SII),and systemic inflammatory response index(SIRI).Gensini scoring system was used to evaluate the severity of coronary artery lesions.SPSS 23.0 statistical software was used for data processing,Pearson or Spearman correlation analysis was used to analyze the correlation between unconventional lipid parameters and inflammatory index and CHD.Multivariate binary Logistic regression was used to analyze the independent influencing factors of CHD occurrence.Receiver operating characteristic curve(ROC)was plotted and area under curve(AUC)was calculated to evaluate the predictive value of unconventional lipid parameters in CHD.Results:1.There was no significant difference in gender,age,BMI,e GFR,smoking,hypertension,diabetes and AF among the four groups(P>0.05).2.Compared with the non-CHD group,there were statistically significant differences in FPG,TG,HDL-C,TG/HDL-C,TyG index,RC/HDL-C,METS-IR in the mild coronary artery disease group(P<0.05);there were significant differences in FPG,TG,HDL-C,SIRI,TG/HDL-C,TyG index and METS-IR in moderate coronary artery disease group(P<0.05);there were significant differences in FPG,TG,HDL-C,SIRI,LVEF,TG/HDL-C,TyG index,TC/HDL-C,non-HDL-C/HDL-C,LDL-C/HDL-C,RC/HDL-C,METS-IR in the severe coronary artery disease(P<0.05).Compared with severe coronary artery disease group,LVEF and TG/HDL-C in mild coronary artery disease group were significantly different(P<0.05).There was significant difference in LVEF between moderate coronary artery disease group and severe coronary artery disease group(P<0.05).3.Compared with the non-CHD group,TG/HDL-C,TyG index,TC/HDL-C,non-HDL-C/HDL-C,LDL-C/HDL-C,RC/HDL-C,METS-IR,SIRI were higher in the CHD group,and the difference was statistically significant(P<0.05).4.Correlation analysis results show that:HDL-C was negatively correlated with CHD,and the difference was statistically significant(P<0.05).TG/HDL-C,TyG index,TC/HDL-C,non-HDL-C/HDL-C,LDL-C/HDL-C,RC/HDL-C,METS-IR,SIRI,FPG,TG were positively correlated with CHD.The difference was statistically significant(P<0.05).5.Multivariate binary Logistic regression analysis showed that TyG index and METS-IR were independent influencing factors for the occurrence of CHD(OR=10.329,95%CI:2.767～38.557,P=0.001;OR=35.454,95%CI:1.369-918.379,P=0.032).6.ROC curve was drawn for CHD by TyG index,METS-IR and their combined indexes,and AUC was calculated.The results showed that:The AUC of TyG index was0.790(95%CI:0.724-0.856),Cut-off value was 8.92,sensitivity was 60.8%,specificity was 92.6%;The AUC of METS-IR was 0.770(95%CI:0.696-0.844),Cut-off value was2.38,sensitivity was 80.0%,specificity was 68.5%;The AUC of TyG index+METS-IR was 0.802(95%CI:0.738-0.867),Cut-off value was 0.66,sensitivity was 71.7%,specificity was 75.9%.Conclusion:1.Non-conventional lipid parameters(TG/HDL-C,TyG index,TC/HDL-C,non-HDL-C/HDL-C,LDL-C/HDL-C,RC/HDL-C,METS-IR)and inflammatory markers(SIRI)were positively correlated with CHD.2.TyG index and METS-IR were independent factors affecting the occurrence of CHD.3.TyG index and METS-IR can be used as predictive parameters to evaluate CHD,and have good predictive value for CHD.The predictive value of TyG index is higher than that of METS-IR when each parameter is tested separately,and the combination of the two indexes has the highest predictive value for CHD.