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Background <p>The increasing prevalence of coronary artery disease (CAD) in young adults necessitates effective early risk assessment tools. Inflammation and dyslipidemia are pivotal in atherogenesis. This study aimed to evaluate the predictive value of high-density lipoprotein cholesterol (HDL-C)-based markers—specifically the neutrophil-to-HDL-C ratio (NHR), the monocyte-to-HDL-C ratio (MHR), and the low-density lipoprotein cholesterol (LDL-C)/HDL-C ratio—for CAD, acute coronary syndrome (ACS), severe coronary stenosis, and clinical prognosis in very young patients.</p> Methods <p>This retrospective study included 1,074 patients aged 18–35 years who underwent coronary angiography. Patients were classified into a CAD group (<i>n</i> = 878) and a non-CAD group (<i>n</i> = 196). Lesion severity was assessed using the Gensini score. Multivariable logistic regression was performed to identify predictors of CAD, ACS, and severe coronary stenosis (Gensini score &gt; 40). Receiver operating characteristic (ROC) curves were used to evaluate the predictive values of NHR, MHR, and the LDL-C/HDL-C ratio. Restricted cubic spline (RCS) regression was employed to explore nonlinear relationships. COX regression was used to assess factors associated with major adverse cardiovascular events (MACE).</p> Results <p>The prevalence of CAD and ACS showed a progressive increase across ascending quartiles of NHR, MHR, and the LDL-C/HDL-C ratio (<i>P</i> for trend &lt; 0.05). After multivariable adjustment, MHR remained an independent risk factor for CAD (<i>P</i> &lt; 0.001), whereas NHR and the LDL-C/HDL-C ratio did not. For ACS, both NHR and MHR were independently associated (<i>P</i> &lt; 0.001). ROC analysis showed MHR and the LDL-C/HDL-C ratio predicted CAD, while NHR exhibited superior predictive value for ACS (AUC = 0.953). Both NHR and MHR independently predicted severe coronary stenosis, with no significant nonlinear association observed via RCS analysis. Over a median follow-up of 7.8 years, smoking, higher Gensini score, and the elevated ratio of LDL-C/HDL-C emerged as independent risk factors for MACE (<i>P</i> &lt; 0.05).</p> Conclusions <p>NHR demonstrates excellent predictive value for ACS and is independently associated with severe coronary stenosis. MHR is an independent risk factor for CAD, while the LDL-C/HDL-C ratio independently predicts long-term MACE. These readily available indices may facilitate early risk stratification and intervention in very young CAD patients.</p>

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Clinical significance and prognostic value of high-density lipoprotein cholesterol-based markers in very young patients with coronary artery disease: a retrospective study

  • 期刊论文

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  • 发表日期：

    2026年4月17日

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  • Jiayin Sun,
  • Shuchang Qi,
  • Meihuizi Yu,
  • Sitong Lei,
  • Wei Han,
  • Yujie Zhou,
  • Dongmei Shi

摘要

Background

The increasing prevalence of coronary artery disease (CAD) in young adults necessitates effective early risk assessment tools. Inflammation and dyslipidemia are pivotal in atherogenesis. This study aimed to evaluate the predictive value of high-density lipoprotein cholesterol (HDL-C)-based markers—specifically the neutrophil-to-HDL-C ratio (NHR), the monocyte-to-HDL-C ratio (MHR), and the low-density lipoprotein cholesterol (LDL-C)/HDL-C ratio—for CAD, acute coronary syndrome (ACS), severe coronary stenosis, and clinical prognosis in very young patients.

Methods

This retrospective study included 1,074 patients aged 18–35 years who underwent coronary angiography. Patients were classified into a CAD group (n = 878) and a non-CAD group (n = 196). Lesion severity was assessed using the Gensini score. Multivariable logistic regression was performed to identify predictors of CAD, ACS, and severe coronary stenosis (Gensini score > 40). Receiver operating characteristic (ROC) curves were used to evaluate the predictive values of NHR, MHR, and the LDL-C/HDL-C ratio. Restricted cubic spline (RCS) regression was employed to explore nonlinear relationships. COX regression was used to assess factors associated with major adverse cardiovascular events (MACE).

Results

The prevalence of CAD and ACS showed a progressive increase across ascending quartiles of NHR, MHR, and the LDL-C/HDL-C ratio (P for trend < 0.05). After multivariable adjustment, MHR remained an independent risk factor for CAD (P < 0.001), whereas NHR and the LDL-C/HDL-C ratio did not. For ACS, both NHR and MHR were independently associated (P < 0.001). ROC analysis showed MHR and the LDL-C/HDL-C ratio predicted CAD, while NHR exhibited superior predictive value for ACS (AUC = 0.953). Both NHR and MHR independently predicted severe coronary stenosis, with no significant nonlinear association observed via RCS analysis. Over a median follow-up of 7.8 years, smoking, higher Gensini score, and the elevated ratio of LDL-C/HDL-C emerged as independent risk factors for MACE (P < 0.05).

Conclusions

NHR demonstrates excellent predictive value for ACS and is independently associated with severe coronary stenosis. MHR is an independent risk factor for CAD, while the LDL-C/HDL-C ratio independently predicts long-term MACE. These readily available indices may facilitate early risk stratification and intervention in very young CAD patients.