Remnant cholesterol, lipid ratios, and the severity of coronary artery lesions: a retrospective cohort study in patients with coronary heart disease.

Emerging genetic and observational evidence indicates that remnant cholesterol (RC) is a significant residual risk factor for cardiovascular diseases. However, there is a relative paucity of evidence exploring the correlation among RC, lipid ratios, and atherosclerotic lesion severity. This study aimed to investigate the predictive value of RC and lipid ratios alone or in combination for the severity of coronary artery stenosis in patients with coronary heart disease (CHD). The Gensini score was used to assess the severity of coronary atherosclerotic lesions. CHD patients were categorized into mild stenosis and moderate-to-severe stenosis groups. Logistic regression was used to evaluate the risk of a high Gensini score associated with RC and lipid ratios. Our study also examined the relationship between inconsistencies in RC and non-high-density lipoprotein cholesterol (non-HDL-C) levels and the severity of coronary artery stenosis. Receiver operating characteristic (ROC) curves were used to assess the predictive power of RC and lipid ratios alone or in combination for moderate to severe coronary artery lesions. Multivariate regression models suggested that RC was a strong predictor of moderate to severe coronary artery stenosis [odds ratio (OR): 5.44, P < 0.001]. When grouped by curve-fitting inflection points, the group with inconsistent high RC/low non-HDL-C, rather than the low RC/high non-HDL-C group, was associated with an increased risk of moderate to severe coronary stenosis compared with the consistent low RC group (OR: 2.72, P < 0.001). ROC curves showed that RC predicted an area under the curve (AUC) of 0.715 for coronary stenosis severity, improving the predictive efficacy of the combined predictors comprising lipid ratios (AUC: 0.723 vs. 0.703, P < 0.05). RC and various lipid ratios [triglyceride/HDL-C, total cholesterol/HDL-C, low-density lipoprotein cholesterol/HDL-C, and apoloprotein (apo)B/apoA] correlated with the degree of coronary artery stenosis in patients with CHD, suggesting that RC has potential value as a biomarker reflecting the degree of coronary artery stenosis independent of the traditional risk factors and the levels of non-HDL-C. This could enhance the predictive efficacy based on the lipid ratio model and had better predictive value for moderate to severe coronary artery lesions.