Association of the low-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio and major adverse cardiac and cerebrovascular events in patients with coronary heart disease undergoing percutaneous coronary intervention: a cohort study

Abstract

Background

Although dyslipidemia increases the risk of coronary heart disease (CHD) and its adverse prognosis, the association between the ratio of low-density lipoprotein cholesterol (LDL-C) to high-density lipoprotein cholesterol (HDL-C) and major adverse cardiovascular and cerebrovascular events (MACCE) after percutaneous coronary intervention (PCI) in patients with CHD has not been adequately demonstrated. Therefore, the aim of this study was to assess the role of LDL-C/HDL-C in the risk of MACCE after PCI in patients with CHD.

Methods

In this large cohort observational study, we enrolled 2226 patients with CHD treated with PCI. LDL-C/HDL-C was considered as an exposure variable and MACCE was considered as an outcome variable. Univariate and multivariate Logistic regression models and subgroup analyses were used to assess the relationship between LDL-C/HDL-C and the risk of MACCE.

Results

A total of 2226 patients (mean age: 60.02 years; 68.00% male) were included in the analysis, and 373 patients suffered MACC. Patients who developed MACCE had higher levels of LDL-C/HDL-C compared to patients who did not develop MACCE [(2.79 ± 1.15) vs (2.64 ± 1.09), p = 0.023]. Univariate Logistic regression analysis showed a correlation between LDL-C/HDL-C and the risk of MACCE (OR: 1.121, 95% CI: 1.019–1.233, p = 0.019). Multivariate Logistic regression analysis showed that higher levels of LDL-C/HDL-C remained strongly associated with a higher risk of MACCE after stepwise adjustment for confounding variables [Model 4: T3 vs T1, OR: 1.455, 95% CI: 1.095-1.933, p = 0.010; per unit increase, OR: 1.158, 95% CI: 1.047–1.281, p = 0.004]. Further subgroup analysis showed that the association between LDL-C/HDL-C and MACCE risk remained in the subgroup ≤60 years, male, without diabetes, and with hypertension (p < 0.05).

Conclusion

Higher LDL-C/HDL-C was closely associated with a higher risk of MACCE after PCI in patients with CHD.

PLAIN LANGUAGE SUMMARY

Low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) are two common parts of blood lipids, and current research has proved that they are linked to coronary heart disease (CHD) and its rates of death. Previous studies have shown that higher LDL-C or lower HDL-C is closely related to the higher occurrence and risk of death for CHD. This new study asked whether LDL-C/HDL-C might also increase the incidence of major cardiovascular and cerebrovascular events (MACCE) in CHD patients. Cardiovascular events describe diseases that affect the heart and its blood vessels whilst cerebrovascular events describe diseases that affect the blood vessels that supply the brain. In this study, which included 2226 patients with CHD who underwent surgery for treatment, it was found that the risk of MACCE in CHD patients with LDL-C/HDL-C level greater than 2.93 was 1.455 times higher than that in patients with LDL-C/HDL-C level lower than 2.12. The team concluded that higher LDL-C/HDL-C is also an important cause of MACCE in patients with CHD who underwent interventional surgery. We still need more research to repeat these connections and to study how they work.

Keywords:

• Low-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio
• coronary heart disease
• percutaneous coronary intervention
• major adverse cardiovascular and cerebrovascular events

Transparency

Declaration of funding

The work was supported by grants from the Jiangsu Provincial Geriatric Health Research Fund Project (LKZ2023010) and the Jiangsu Provincial Social Science Fund Project (19GLD001).

Declaration of financial/other relationships

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

Xiaomei Ren: Writing - review & editing. Xiaomei Ren: Data curation, Writing - original draft. Xia Wang: Conceptualization, Methodology, Software. Xiaomei Ren: Conceptualization, Funding acquisition, Project administration, Supervision. All authors read and approved the final manuscript.

Acknowledgements

Authors would like to thank all the patients, nurses, doctors and researchers who participated in the original study for their valuable contributions.

Data availability statement

The datasets used/or analyzed during the current study are available from the corresponding author on reasonable request.

Ethics statement

The original study protocol was approved by the Ethics Committee of the First affiliated Hospital of Zhengzhou University and complied with the Declaration of Helsinki. And informed consent was waived for all patients due to the nature of the retrospective study by the Ethics Committee of the First affiliated Hospital of Zhengzhou University.