Usefulness of Novel Atherogenic Lipid Indices for the Evaluation of Metabolic Status Leading to Coronary Heart Disease in a Real-World Survey of the Japanese Population

We evaluated the usefulness of two novel cholesterol-triglyceride subgroup (CTS) indices, CTS(qlt) and CTS(qnt), that potentially reflect the metabolic status regarding risk of coronary heart disease (CHD) using a retrospective longitudinal study of the Japanese general population. We recruited 12,373 individuals from the annual users of our healthcare center. Among them, the first onset of CHD was recorded in 131 individuals between April 2014 and March 2020. The multivariate Cox proportional hazards regression analyses for all normalized lipid indices revealed that the CTS(qnt) index showed a comparable hazard ratio for the CHD outcome to non-high-density lipoprotein cholesterol (nonHDL-c) and triglycerides. The HR of the CTS(qlt) index was significantly lower than for CTS(qnt), but still comparable to that for low-density lipoprotein cholesterol (LDL-c). In comparison with the other indices, CTS(qlt) is more sensitive to risk increment while the index value increases. Linear regression analyses for the CTS indices and previously known lipid indices suggest that the CTS(qnt) and CTS(qlt) indices reflect the quantity of atherogenic lipoproteins and particle size (quality) of smaller and denser LDLs, respectively. Furthermore, the CTS(qnt)/HDL-c index can be used as a comprehensive risk indicator that may represent the status of lipid metabolism determined by the CTS(qlt) and CTS(qnt) indices and thus may be useful for screening. The CTS indices can be used to evaluate the metabolic status of individuals, which may increase the risk of future CHD.