Non-HDL-c/TC: A Novel Lipid-Related Marker in the Assessment of Severity of Coronary Artery Lesions and Cardiovascular Outcomes

BACKGROUND: Non-high-density lipoprotein cholesterol (non-HDL-c) predicts the severity of coronary artery lesions in patients not treated with statin. The association between non-HDL-c and severity of coronary artery lesions in patients treated with lipid-lowering therapy has been unknown. HYPOTHESIS: We hypothesize a novel marker of non-HDL-c/TC predicts the severity of coronary artery lesions and clinical outcomes in 12 months in the patients treated with statin. METHOD: 473 subjects who met inclusion criteria were eligible for inclusion. Coronary artery angiography (CAG) was performed, and the Gensini score (GS) was calculated in all the subjects divided into three subgroups of low risk, medium risk, and high risk by the tertiles of GS. The non-HDL-c value was calculated as TC minus HDL-c, while non-HDL-c/TC was the ratio of non-HDL-c and TC. RESULTS: The concentration of non-LDL-c differed between non-obstructive-CAD group and obstructive-CAD group (P < 0.05), and non-HDL-c/TC was elevated in the obstructive-CAD group (P < 0.05). Increased GS was associated with increasing non-HDL-c/TC (P < 0.05). Non-HDL-c/TC (OR: 108.50, 95% CI: 1.57–7520.28; P=0.030) remained as an independent predicting factor of high risk under GS stratification. In unadjusted Cox model, high non-HDL-c/TC (RR: 1.976, 95% CI: 1.155–3.382; P=0.013) predicted the occurrence of adverse events. After multivariate adjustment, high non-HDL-c/TC (RR: 1.921, 95% CI: 1.105–3.339; P=0.021) was an independent predictor of poor outcomes. CONCLUSION: High level of non-HDL-c/TC presented an excellent prognostic value compared with other lipid-related markers in CAD patients treated with statin.