Effect of combining sST2/HDL-C ratio with risk factors of coronary heart disease on the detection of angina pectoris in Chinese: a retrospective observational study

BACKGROUND: Soluble suppression of tumorigenicity 2 (sST2), a member of the interleukin-1 receptor family, binds IL-33, preventing its interaction with membrane-bound form ST2 (ST2L), thereby blocking its protection against atherosclerosis. High-density lipoprotein cholesterol (HDL-C), a variety of lipoproteins with mean size of 8–10 nm and density of 1.063–1.21 g/mL, not only acts as lipid transporters that transport cholesterol reversely, but also carries a variety of proteins and microRNAs endowing it with the ability to prevent cardiovascular disease. Most studies on the relationship between sST2 and coronary heart disease (CHD) are limited to acute myocardial infarction (AMI). The present study set out to investigate the association between the sST2/HDL-C ratio and angina pectoris. METHODS: A retrospective single-center cohort study was conducted and a total of 250 patients with chest pain that formed a convenience series, hospitalized between January 2018 and August 2020, were enrolled. Patients with AMI, acute and chronic heart failure, structural heart disease, renal insufficiency [estimate glomerular filtration rate (eGFR) <60 mL/min/1.73 m(2)], rheumatic immune diseases, malignant tumors and severe infections were excluded. Patients with missing data were also excluded. Two hundred and nine patients were finally enrolled. Levels of sST2, HDL-C and sST2/HDL-C ratio were measured and calculated after admission. The angina pectoris was diagnosed by combining clinical features, coronary angiography results and cardiac troponin I levels. The diagnosis value of sST2/HDL-C on angina pectoris was analyzed by binary logistic analysis and the receiver operating characteristic (ROC) curve and area under the ROC curve (AUC) assesses. RESULTS: Patients with stable angina pectoris (SAP) or unstable angina pectoris (UAP) accounted for a larger proportion (28.8% vs. 42.9%, P=0.035) in patients with the higher sST2/HDL-C ratio. Binary logistics regression showed that for every unit of sST2/HDL-C increase, the risk of angina pectoris increased by 38.8% (OR =1.388, P=0.018). By subgroup analysis, a stronger association was found in non-diabetic patients (OR =1.551, P=0.006), non-hypertension patients (OR =1.700, P=0.025), non-smokers (OR =1.527, P=0.049) and patients aged <65 y (OR =1.693, P=0.019). ROC curve showed that AUC was higher [0.643 (0.566, 0.719) vs. 0.618 (0.540, 0.696)] and the sensitivity of diagnosis increased significantly (84.0% vs. 49.3%) by combining sST2/HDL-C with risk factors of CHD. CONCLUSIONS: A higher ratio of sST2/HDL-C was associated with an increased risk of angina pectoris. sST2/HDL-C combined with CHD risk factors showed increased diagnostic value in identifying angina pectoris. TRIAL REGISTRATION: Clinical trial: ChiCTR-DDD-17013908.