| Objective:Non high density lipoprotein cholesterol has been widely affirmed in the evaluation of the prognosis of coronary heart disease.The purpose of this study was to investigate: 1.The relationship between non High Density Lipoprotein Cholesterol to High Density Lipoprotein Cholesterol ratio and and coronary heart disease,as well as the association between this ratio and the severity of coronary artery disease;2.The predictive value of non-HDLC/HDL-C ratio in CHD evaluation and prognosis.Methods: The study is divided into two parts.In the first part,totally 930 patients were enrolled and classified them into CHD group(stenosis ≥ 50% in at least one major coronary artery,680 cases)and normal group(250 cases)according to their results of coronary angiography(CAG).Then divide the CHD group into SA group(339 cases)and ACS group(341 cases).Laboratory data including fasting lipid profile,fasting glucose profile,liver and renal functions and myocardial enzymes spectrum were obtained at baseline.Analyze the relationship between non-HDL-C/HDL-C ratio and coronary heart disease(CHD),stable angina pectoris(SA)and acute coronary syndrome(ACS).ROC curve analysis was used to determine the value of non-HDL-C/HDL-C ratio in the diagnosis of CHD as well as SA and ACS.Inside and outside hospital prognosis(7.51 + 0.57),was followed to analyze the assosiation with non-HDL-C/HDL-C ratio and the CHD patients,SA patients as well as the prognosis of patients with ACS.In the second part,829 patients with complete medical history were classified into control group(250 cases),single-branch stenosis(188 cases),double-branch stenosis(184 cases)and multi-branch stenosis(207 cases)according to the CAG results.Laboratory data was obtained at baseline and non-HDL-C/HDL-C ratio was calculated for the analysis of the relationship between the ratio and the severity of CHD.Results:Part one: The non-HDL-C/HDL-C ratio in CHD group was higher than those in the normal group [(3.146±0.892 VS 3.305±1.079),P <0.001].After adjustment for age,sex,BMI,smoking history,HBP and DM history,the non-HDLC/HDL-C ratio was closely associated with CHD.[(OR = 1.510,95% CI 1.271~ 1.794),P <0.001].The ROC curve analysis for ACS showed: the index area of non-HDL-C/HDL-C ratio was 0.605(95% CI:0.588-0.652),better than LDL-C,non-HDL-C and ApoB,but less than hsCRP,CK-MB and TNI.The best cut-off point of diagnosis was 3.092,sensitivity was 0.497,specificity was 0.664;the CHD group was further divided into SA group and ACS group,the non-HDL-C/HDL-C ratio of SA group and ACS group were both higher than that of normal group,there was significant difference(P<0.05);After adjustment for gender,age,BMI,DM,HBP history and smoking history,results about the SA group showed that the OR non-HDL-C/HDL-C of was 1.365(95%CI:1.139-1.67,P=0.001)];results about the ACS group showed that the OR value was 1.975(95%CI:1.577-2.473,P < 0.001)],non-HDLC/HDL-C was related with both ACS and SA.ROC curve analysis showed that for SA,the area of non-HDL-C/HDL-C ratio was 0.565(95% CI: 0.515-0.614,P=0.012),the best diagnostic cut-off point was 4.067,the sensitivity was 0.209,specificity was 0.904;for ACS: the area of non-HDLC/HDL-C was 0.645(95% CI: 0.593-0.698),the best cut-off point for the diagnosis of ACS was 3.092,sensitivity was 0.569,specificity was 0.664.For CHD patients with diabetes,analysis found that the non-HDL-C/HDL-C ratio in CHD patients combined with DM or CHD patients combined with IGT/IFG did not differ significantly from patients with simple CHD.In hospital prognosis analysis found that the non-HDL-C/HDL-C ratio of patients with in hospital cardiovascular events had no statistically significant difference with the other patients(3.266±1.494 VS 3.063±1.237,P>0.05);The non-HDL-C/HDL-C ratio of the deaths had no statistically significant difference with the other patients either(3.056±1.052 VS 3.085±1.256,P>0.05);While the non-HDL-C/HDL-C ratio of patients with new onset heart failure was significantly higher than the other patients(3.538±1.618 VS 3.055±1.235,P=0.005).Follow up out of hospital(7.51 + 0.57 years)found that in CHD patients with the occurrence of cardiovascular events,the non-HDL-C/HDL-C ratio was significantly higher than that in the other patients(3.63±1.49 VS 3.04±1.18,P<0.001).In the patients with new / recurrent MI and patients with new onset heart failure,the ratio of non-HDL-C/HDL-C were significantly higher than those patients that did not occur [MI(4.33 + 1.96)vs.(3.21 + 1.27)],P<0.001,[HF(3.84 + 1.64)vs.(3.23 + 1.31)P=0.010].ROC curve analysis showed that the area under the line for outside of hospital cardiovascular events was 0.622,(P<0.001,95%CI0.558~0.686).The best cut-off point was 3.654,the sensitivity was 0.464 and the specificity was 0.732.For new / recurrent MI,the area of non-HDL-C/HDL-C ratio was 0.726(P=0.001,95%CI 0.592~0.859),the best cut-off point was 4.274,the sensitivity was 0.556,the specificity was 0.830.For the outside hospital heart failure,the area of non-HDL-C/HDL-C was 0.676(P=0.006,95%CI 0.553~0.799),the best cut-off point was 4.633,the sensitivity was 0.343,the specificity was 0.872.Part two: The non-HDL-C/HDL-C ratio had differences between normal group and single-branch group,normal group and double-branch group as well as normal group and multibranch group.There are also differences between singlebranch group and double-branch group,as well as between single-branch group and multi-branch group(P<0.01).After adjustement of other factors,the OR of this ratio with double-branch lesions was 1.230(95%CI:1.054-1.436,P=0.009)],and OR with multi-branch lesions was 1.326(95%CI:1.158-1.519,P<0.001)],which showed that this ratio had significant association with double-branch lesions.And multi-branch lesions.While in the CHD patients divided into groups(mild,moderate,severe)according to Gensini score,the non-HDL-C/HDL-C ratio of each group was significantly higher than the normal group,but there was no significant statistical difference between the groups.Conclusions: 1.The non-HDL-C/HDL-C ratio was significantly increased in CHD patients.The ratio was closely asssociated with CHD.2.The non-HDL-C/HDL-C ratio was valuable in the diagnosis of CHD.3.The non-HDL-C/HDL-C ratio could contribute to predict short-term and long-term prognosis of CHD patients,predict the risk of cardiovascular events,especially heart failure incidences.That conclusion also worked for patients who had CHD complicated with diabetes or impaired glucose tolerance.4.The non-HDL-C/HDL-C ratio was increased in SA patients,the ratio was associated with the onset of SA,and had a predictive value in assessing the occcurence of cardiovascular events.5.The non-HDL-C/HDL-C ratio was significantly increased in ACS patients,and the association between this ratio and ACS was more significant than that between this ratio and SA.The ratio was associated with the onset of ACS,and had a predictive value in assessing the occcurence of cardiovascular events.6.The non-HDL-C/HDL-C ratio was closely related with the numbers of coronary arteries stenosis but we did not find significant association between this ratio and Gensini score.After all,the non-HDL-C/HDL-C ratio can be used as one of the tools to assess CHD prognosis and predict the incidence of cardiovascular events especially the newonset/recurrence myocardial infarction and heart failure.3.The non-HDL-C/HDL-C ratio could contribute to predict short-term and long-term prognosis of CHD patients,predict the risk of cardiovascular events,especially heart failure incidences.That conclusion also worked for patients who had CHD complicated with diabetes or impaired glucose tolerance.4.The non-HDL-C/HDL-C ratio was increased in SA patients,the ratio was associated with the onset of SA,and had a predictive value in assessing the occcurence of cardiovascular events.5.The non-HDL-C/HDL-C ratio was significantly increased in ACS patients,and the association between this ratio and ACS was more significant than that between this ratio and SA.The ratio was associated with the onset of ACS,and had a predictive value in assessing the occcurence of cardiovascular events.6.The non-HDL-C/HDL-C ratio was closely related with the numbers of coronary arteries stenosis but we did not find significant association between this ratio and Gensini score.After all,the non-HDL-C/HDL-C ratio can be used as one of the tools to assess CHD prognosis and predict the incidence of cardiovascular events especially the newonset/recurrence myocardial infarction and heart failure. |
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