The Correlation Of Lipoprotein Ratios With Coronary Heart Disease And The Severity Of Coronary Atherosclerosis In Han Population

Objective: To investigate whether the lipoprotein ratios are superior to conventional lipid parameters in predicting the risk of coronary heart disease(CHD) and the severity of coronary atherosclerosis(AS) by exploring the correlations between the lipoprotein ratios and CHD and the severity of AS.Methods: A total of 949 inpatients who were suspected as CHD and undergone coronary angiography in the Affiliated Hospital of North Sichuan Medical College from May 2011 to April 2014. According to the results of coronary angiography, the included subjects were divided into CHD group(n=792) and control group(n=157). The CHD group was either divided into four subgroups by the Gensini score or into three subgroups by the number of stenotic vessels. Demographic characteristics, plasma lipids, UCG and coronary angiography data of the subjects were collected. All statistical analyses were done using SPSS version 13.0, differences were considered significant if p<0.05.Results: 1. The correlations between biochemical and physiological factors and the risk of CHD are as follows: CHD group had significantly higher age, non-HDL-C, Lp(a), TG/HDL-C, TC/HDL-C, LDL-C/HDL-C, non-HDL-C/HDL-C, VLDL-C/HDL-C and Apo B100/Apo AI, and prevalence of males, cigarette smokers, hypertensive patients than the control group. The results from univariate logistic regression analysis showed that the ratios of TC/HDL-C, LDL-C/HDL-C, non-HDL-C/HDL-C and Apo B100/Apo AI increased the risk for CHD. By multivariate logistic regression analysis, higher ratios of TC/HDL-C, LDL-C/HDL-C, non-HDL-C/HDL-C and apo B100/apo AI were independently associated with CHD after adjustment with nonlipid coronary risk factors(age, sex, weight, BMI, alcohol drinking, cigarette smoking, hypertension and type 2 diabetes). The association of apo B100/Apo AI with CHD was stronger than other lipoprotein ratios in the univariate and multivariate logistic regression analyses. 2. The correlations between biochemical and physiological factors and the severity of coronary atherosclerosis are as follows:(1) In the Gensini score group: group 3 had significantly higher prevalence of smokers and Lp(a) levels than group 1 and 2, and lower levels of Apo AI than group 2. Group 4 had significantly higher LDL-C/HDL-C, Apo B100/Apo AI than the other three groups, higher age, smoking and diabetes prevalence than group 1, higher male prevalence and, Lp(a) levels than group 1 and 2, and lower HDL-C and Apo AI levels than the other three groups.(2) In the groups stratified by the stenotic vessels, 2-vessel stenosis group had significantly higher prevalence of males and smokers, and levels of TG, TC, non-HDL-C, LDL-C, Apo B100, Lp(a), TG/HDL-C, TC/HDL-C, LDL-C/HDL-C and Apo B100/Apo AI than 1-vessel stenosis group. Multi-vessel stenosis group had significantly higher age and Lp(a) than 1-vessel and 2-vessel stenosis groups, higher prevalence of males, smokers and diabetes, and levels of TG, TC, HDL-C, non-HDL-C, LDL-C, Apo B100, TG/HDL-C, TC/HDL-C, LDL-C/HDL-C and Apo B100/Apo AI than 1-vessel stenosis group, lower level of HDL-C than 1-vessel stenosis group, and lower level of Apo AI than 1-vessel and 2-vessel stenosis groups.(3) The univariate logistic regression analyses showed that higher prevalence of males and smokers and levels of age, Lp(a), TC/HDL-C, LDL-C/HDL-C and Apo B/Apo AI were positively associated with the Gensini score, whereas higher levels of HDL-C and Apo AI were negatively associated with the Gensini score. Higher prevalence of males, smokers, diabetic patients and hypertension patients and higher levels of age, TG, TC, LDL-C, HDL-C, Apo AI, Apo B100, Lp(a), TG/HDL-C, TC/HDL-C, LDL-C/HDL-C, VLDL-C/HDL-C and Apo B100/Apo AI were positively associated with the number of stenotic vessels, where as higher levels of HDL-C and Apo AI were negatively associated with the number of stenotic vessels.(4) The multiple logistic regression analyses showed that LDL-C/HDL-C and TC/HDL-C were independently associated with the severity of coronary atherosclerosis after adjustment for other risk factors(age, males, weight, BMI, cigarette smoking, alcohol drinking, hypertension and diabetes), but the results changed to contrary when Apo B100/Apo AI was employed to the equation. However, Apo B100/Apo AI was consistently associated with the severity of coronary atherosclerosis after adjustment for age, sex, weight, BMI, cigarette smoking, alcohol drinking, hypertension, diabetes, TC, HDL-C, TC/HDL-C and LDL-C/HDL-C(Analyzed by Gensini score: OR=3.54, 95%CI=1.44-8.71; Analyzed by stenotic vessel: OR=2.92, 95%CI=1.31-6.53).Conclusion: The results of this study suggest that the lipoprotein ratios(TC/HDL-C,LDL-C/HDL-C,Apo B100/Apo AI)are better predictors of CHD and the severity of coronary atherosclerosis in Han population than conventional lipid parameters, and Apo B100/Apo AI could be the best one. Further case-control studies with multicenter, large sample and high quality design are needed to confirm our findings.