A study on the prediction of TC/HDL-C, TyG, CysC and LAD for ischemic stroke in patients with coronary heart disease

doi:10.11958/20253309

Abstract

Abstract:

Objective To evaluate the predictive value of serum total cholesterol to high-density lipoprotein cholesterol ratio (TC/HDL-C), triglyceride-glucose index (TyG), cystatin C (CysC) and left atrial diameter (LAD) in patients with coronary heart disease (CHD) complicated with ischemic stroke. Methods One hundred patients with CHD complicated with ischemic stroke were enrolled as the comorbidity group, while another 100 CHD patients without a history of ischemic stroke were selected as the control group. Baseline characteristics and laboratory parameters were retrospectively collected in both groups. Echocardiography was performed to measure left ventricular end-diastolic diameter (LVEDd), LAD and left ventricular ejection fraction (LVEF). Binary Logistic regression analysis was performed to identify factors influencing ischemic stroke in CHD patients. Based on the identified factors, a nomogram prediction model was constructed. The predictive value of the nomogram model was then assessed using receiver operating characteristic (ROC) curve analysis and decision curve analysis. Results The proportion of hypertension, TC/HDL-C ratio, TyG, CysC and LAD were higher in the comorbidity group compared to those of the control group (P<0.05). Logistic regression analysis identified that elevated TC/HDL-C, TyG, CysC and LAD were independent risk factors for ischemic stroke in patients with CHD. A nomogram prediction model was subsequently constructed based on these four indicators. The model exhibited good discriminative ability, with a concordance index of 0.880. ROC curve analysis showed an area under the curve of 0.880 (95% CI: 0.834-0.927) for predicting ischemic stroke. The optimal cut-off value was 51.80 points, with a specificity of 0.760, sensitivity of 0.880 and the Youden's index of 0.640. Decision curve analysis revealed that the nomogram model provided a higher net benefit than any single indicator when the prediction probability threshold was set between 10% and 30%. Conclusion TC/HDL-C, the TyG, CysC and LAD are significant factors influencing ischemic stroke in patients with CHD. The nomogram model constructed based on these factors demonstrates potential utility for predicting this risk.

Key words: coronary disease, ischemic stroke, cholesterol, HDL, triglycerides, triglyceride-glucose index, cystatin C, left atrial diameter

CLC Number:

R541.4

Figures/Tables 7

References 25

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组别		年龄≥60岁				性别（男/女）			BMI≥24 kg/m²				糖尿病
冠心病组		70（70.00）				63/37			64（64.00）				25（25.00）
合并症组		73（73.00）				65/35			62（62.00）				28（28.00）
χ²或t		0.221				0.087			0.086				0.231
组别	高血压				病变血管数（单支）					TC/HDL-C				TyG
冠心病组	26（26.00）				45（45.00）					3.89±0.78				8.13±1.01
合并症组	40（40.00）				43（43.00）					4.71±0.85				8.95±1.06
χ²或t	4.432^＊				0.081					6.980^＊				5.602^＊
组别			CysC/（mg/L）				Hcy/（μmol/L）					LVEDd/mm
冠心病组			0.92±0.23				20.58±2.54					46.96±3.36
合并症组			1.09±0.25				21.03±2.55					47.32±3.51
χ²或t			5.218^＊				1.269					0.740
组别				LAD/mm				LVEF/%			ALT/（U/L）
冠心病组				37.19±3.52				60.54±5.98			83.26±6.19
合并症组				39.42±3.48				59.75±5.92			83.52±6.42
χ²或t				4.524^＊				0.950			0.303

组别		年龄≥60岁				性别（男/女）			BMI≥24 kg/m²				糖尿病
冠心病组		70（70.00）				63/37			64（64.00）				25（25.00）
合并症组		73（73.00）				65/35			62（62.00）				28（28.00）
χ²或t		0.221				0.087			0.086				0.231
组别	高血压				病变血管数（单支）					TC/HDL-C				TyG
冠心病组	26（26.00）				45（45.00）					3.89±0.78				8.13±1.01
合并症组	40（40.00）				43（43.00）					4.71±0.85				8.95±1.06
χ²或t	4.432^＊				0.081					6.980^＊				5.602^＊
组别			CysC/（mg/L）				Hcy/（μmol/L）					LVEDd/mm
冠心病组			0.92±0.23				20.58±2.54					46.96±3.36
合并症组			1.09±0.25				21.03±2.55					47.32±3.51
χ²或t			5.218^＊				1.269					0.740
组别				LAD/mm				LVEF/%			ALT/（U/L）
冠心病组				37.19±3.52				60.54±5.98			83.26±6.19
合并症组				39.42±3.48				59.75±5.92			83.52±6.42
χ²或t				4.524^＊				0.950			0.303

变量	β	SE	Wald χ²	P	OR	OR 95%CI
高血压	-0.336	0.440	0.584	0.445	0.714	0.302~1.693
TC/HDL-C	1.309	0.257	25.963	<0.001	3.701	2.237~6.122
TyG	0.727	0.188	14.899	<0.001	2.068	1.430~2.991
CysC	4.129	0.931	19.671	<0.001	62.141	10.020~385.382
LAD	0.212	0.058	13.538	<0.001	1.236	1.104~1.384
常数项	-23.874	3.534	45.631	<0.001	0.000	-

变量	β	SE	Wald χ²	P	OR	OR 95%CI
高血压	-0.336	0.440	0.584	0.445	0.714	0.302~1.693
TC/HDL-C	1.309	0.257	25.963	<0.001	3.701	2.237~6.122
TyG	0.727	0.188	14.899	<0.001	2.068	1.430~2.991
CysC	4.129	0.931	19.671	<0.001	62.141	10.020~385.382
LAD	0.212	0.058	13.538	<0.001	1.236	1.104~1.384
常数项	-23.874	3.534	45.631	<0.001	0.000	-