The Association Between Triglyceride To High Density Lipoprotein Cholesterol Ratio And Coronary Collateral Circulation

BackgroundCoronary heart disease has become the main cause of death in developing countries.According to China cardiovascular disease report 2018,the current population of coronary heart disease in China is estimated to be 11 million,and the prevalence and mortality of urban and rural residents are still on the rise.Coronary collateral circulation(CCC)refers to the tiny blood flow channels between the coronary arteries,which is closed under physiological conditions.When the main coronary arteries are severely stenosed or completely occluded,these vessels gradually open and form functional collateral circulation under the stimulation of hypoxia,inflammatory factors and other factors.As an adaptive response to myocardial ischemia,CCC is beneficial to reduce myocardial ischemic injury,enhance residual myocardial contractility,reduce angina pectoris symptoms and adverse cardiovascular events.Studies have shown that in adults with increased cardiovascular metabolic risk,the individual values of TG,HDL-C and LDL-C do not always reflect the overall cardiovascular risk of these populations.Compared with single lipid index,TG/HDL-C ratio had a better prediction ability for cardiovascular disease.Previous studies have found that the TG/HDL-C ratio is negatively correlated with islet β-cell function,which is a good marker of insulin resistance,but also independently related to the occurrence of non-alcoholic fatty liver disease.Moreover,insulin resistance can accelerate the process of atherosclerosis,and the insulin resistance index has a certain predictive value for the severity of coronary artery disease.A clinical study involving 233 patients with coronary heart disease showed that the TG/HDL-C ratio increased with the number of coronary artery lesions and was independently related to the Gensini score,which was a method to evaluate the severity of coronary artery lesions.After in-hospital observation and three-year out-of-hospital clinical follow-up,it was found that TG/HDL-C ratio was also associated with new-onset heart failure and long-term adverse cardiovascular events.A prospective clinical study showed that TG/HDL-C ratio is an independent predictor of all-cause mortality after percutaneous coronary intervention(PCI)in patients with acute coronary syndrome(ACS).A retrospective clinical study in China shows that TG/HDL-C ratio was independently related to the formation of CCC in elderly patients with acute ST segment elevation myocardial infarction.At present,there is no research report on the relationship between TG/HDL-C ratio and CCC in patients with chronic total occlusion(CTO)at home and abroad.ObjectiveThe purpose of this study was to investigate the relationship between triglyceride/HDL-C ratio and collateral circulation formation in patients with chronic total occlusion of coronary artery.Method181 patients with at least one main coronary artery(left anterior descending branch,circumflex and right coronary artery)CTO confirmed by selective coronary angiography in cardiovascular department of the First Affiliated Hospital of Zhengzhou University from August 2017 to December 2018 were selected as the study objects.According to Rentrop grading method,patients were divided into good CCC group(Rentrop 2-3,102 cases)and poor CCC group(Rentrop 0-1 grade,79 cases).The baseline data,clinical indicators,medication and the location of diseased blood vessels of the two groups were compared.Binary multivariate regression analysis was used to analyze the risk factors of CCC formation in patients with CTO.The receiver operating characteristic curve was used to evaluate the value of TG/HDL-C ratio in predicting the formation of CCC.Result1.The proportion of smoking history,TG/HDL-C ratio,fasting blood glucose and blood uric acid in the group with poor CCC were significantly higher than those in the group with good CCC(P<0.05),while the proportion of right coronary occlusion was lower than those in the group with good CCC.2.Binary multivariate logistic regression analysis showed that increased TG/HDL-C ratio(OR:1.811,95%CI:1.314-2.497,P<0.001),elevated fasting blood glucose(OR:1.298,95%CI:1.112-1.515,P=0.001)and smoking history(OR:3.298,95%CI:1.542-7.056,P=0.002)were independent predictors for poor CCC formation.3.The ROC curve showed that the area under the curve for TG/HDL-C ratio predicting poor CCC formation was 0.715(95%CI:0.638-0.792,P<0.001),with optimal cut-off value of 1.606 indicating a sensitivity of 63.3%and a specificity of 78.4%.Conclusion1.In patients with CTO,the increase of TG/HDL-C ratio is closely related to poor CCC formation,and is an independent risk factor for predicting poor CCC formation.