Monocyte/HDL Cholesterol Ratio and Atherogenic Indexes as Predictors of Coronary Artery Disease Severity and Angiography Need in Patients Undergoing Coronary CT Angiography

Abstract

Background: Coronary artery disease (CAD) is a leading global cause of mortality, with dyslipidemia and inflammation playing central roles in its pathogenesis. While traditional lipid markers are widely used, non-traditional lipid indices may offer superior predictive value for CAD severity. Additionally, the monocyte/HDL-cholesterol ratio (MHR) has emerged as a novel marker combining lipid metabolism and inflammation, offering potential as a predictor of cardiovascular risk. However, existing studies often overlook gender-specific differences in these indices for predicting CAD severity and the need for invasive coronary angiography (ICA). Objectives: This study investigates the predictive value of MHR and other lipid indices in assessing CAD severity and ICA necessity in male and female patients undergoing coronary computed tomography angiography (CCTA). Patients and Methods: This retrospective study included 419 patients (207 males, 212 females) who underwent CCTA at a tertiary hospital between January 1 and August 1, 2024, after applying exclusion criteria (patients with missing atherogenic index data, prior coronary interventions, unclear coronary assessments, known CAD, severe valvular disease, or aortic aneurysm). Patients were classified into two grouping systems based on CAD-RADS (CAD - Reporting and Data System) scores: Grouping 1 (six CAD-RADS categories) and Grouping 2 (CAD-RADS 0 - 2 vs. 3 - 5). The MHR, plasma atherogenic index (PAI), Atherogenic Coefficient (AC), Castelli Risk Index-I and II (CRI-I, and CRI-II) were analyzed, with P ≤ 0.05 considered statistically significant. Results: When classified into six CAD-RADS groups, the CAD-RADS-0 group was significantly younger than groups 1 - 4 (P = 0.003, < 0.001, < 0.001, and < 0.001, respectively). A significant gender difference was also found among the groups (P < 0.001), but no significant differences in MHR, PAI, AC, CRI-I, or CRI-II were observed. However, when grouped as CAD-RADS 0 - 2 vs. 3 - 5, gender distribution differed significantly (P < 0.001), and MHR, AC, CRI-I, and CRI-II were significantly higher in the CAD-RADS 3 - 5 group (P = 0.029, 0.017, 0.017, 0.008, respectively), with no significant difference in PAI (P = 0.250). Further gender-based analysis within the CAD-RADS 0 - 2 and CAD-RADS 3 - 5 groups revealed no significant differences in lipid indices between subgroups. Conclusion: While MHR, AC, CRI-I, and CRI-II differed between CAD-RADS 0 - 2 and 3 - 5 groups, these associations disappeared in further gender-based analysis. Gender-based lipid reference value differences may confound the predictive value of these variables, necessitating cautious interpretation.