Journal Article

Evaluating Body Mass Index to High-Density Lipoprotein Cholesterol (BMI/HDL-C) Ratio in Predicting Coronary Artery Disease: A Multicenter Study

Huma, Sarwat, Shalaby, Abdulrahman H, Farahat, Ali Hosni, Alsayyad, Mohammad, Hassan Ali, Ahmed, Fayk, Ayman, Lashin, Hesham El Sayed, Tahirud Din, Qazi, Tahir, Nafisa, Shabana, Hossam, Abd Elnasser, Waleed Saber, Said, Ibrahim Faragallah, Mekheimar, Magdy Ahmed Mohamed, Saba, Ahmed M, Yunus, Mohammed, El-Mahalawy, Mostafa Haseeb, Sabrh, Mostafa, Paul, Bhaskar, Hassan, Omar Hassan El Metwally, Ali, Osama Safwat Hamed, Abotaha, Ahmed Ahmed, Alhawy, Ahmed Mohamed Ewis, Ashraf, Muhammad, Ayoub, Hazem Sayed Ahmed, Elmezain, Reda Fakhry Mohamed, Abdelraouf, Mahmoud, Khalaf, Hani Abdelshafook, Habila, Mohamed El Saeed Mohamed, Ibrahim, Ahmed Mahrous Ahmed, Aladl, Hossam Aladl Aladl, Ullah, Himayat, Fouad, Tamer Ahmed, Kassem, Arafat

2026

Overview

The purpose of the study is to search for simple, widely available markers that combine adiposity and lipoprotein status to improve coronary artery disease (CAD) risk discrimination. For this, we evaluated whether the body mass index to high-density lipoprotein cholesterol ratio (BMI/HDL-C) discriminates angiographically confirmed CAD better than BMI or HDL-C alone. In this multicenter observational study, we enrolled 834 adults undergoing coronary angiography at three tertiary centers. CAD was defined as ≥50% stenosis in ≥1 major coronary artery and its branches. BMI and fasting HDL-C were measured on admission; BMI/HDL-C was calculated. We assessed associations using Spearman correlation, logistic regression, receiver operating characteristic (ROC) analysis, and Area under the curve (AUC). Mean age was 58.5 ± 11.9 years; 53.7% were male; 440 had CAD. BMI/HDL-C correlated most strongly with CAD (rho = 0.68) versus HDL-C (rho = -0.65) and BMI (rho = 0.142). In logistic regression (after adjusting for Diabetes Mellitus, Hypertension, dyslipidemia, and smoking), a one-unit increase in the HDL-C was associated with a 26.2% reduction in the odds of CAD, while a 6.4% and 55.2% increase in the odds of CAD was noted with a one-unit increase in the BMI and BMI/HDL ratio, respectively. ROC analysis showed superior discrimination for BMI/HDL-C (AUC 0.892; 95% CI 0.870-0.913) compared with HDL-C (AUC 0.875; 95% CI 0.849-0.901) and BMI (AUC 0.582; 95% CI 0.543-0.621). An optimal BMI/HDL-C cutoff of 19.7 achieved 100% sensitivity and 83.5% specificity. AUC differences were statistically significant (p < 0.001). In conclusion, the BMI/HDL-C ratio demonstrated superior discriminatory ability for angiographically defined CAD compared to BMI or HDL-C alone, suggesting its potential as a simple and clinically useful marker, although further validation in prospective studies is warranted.

• Publisher: Dove Press,Dove Medical Press
• Subject: Adiposity / Aged / Biomarkers - blood / BMI / BMI/HDL ratio / Body Mass Index / CAD / Cholesterol, HDL - blood / Coronary Angiography / coronary artery disease / Coronary Artery Disease - blood / Coronary Artery Disease - diagnostic imaging / Coronary Stenosis - blood / Coronary Stenosis - diagnostic imaging / Female / HDL-C / high-density lipoprotein cholesterol / Humans / Male / Middle Aged / Obesity - blood / Obesity - complications / Obesity - diagnosis / Original Research / Predictive Value of Tests / Prognosis / Risk Assessment / Risk Factors / risk stratification / Tertiary Care Centers