Non-high-density lipoprotein cholesterol shows a dose-response relationship with coronary artery lesions in patients with acute coronary syndromes

Background Cardiovascular disease (CVD) is the leading cause of death worldwide. Non-high-density lipoprotein cholesterol (non-HDL-C), encompassing all potentially atherogenic cholesterol, correlates significantly with atherosclerotic cardiovascular disease (ASCVD). Recent guidelines have endorsed non-HDL-C as a therapeutic target for lipid-lowering therapy in patients with CVD. However, few studies have examined the relationship between non-HDL-C levels and coronary artery disease extent in patients with acute coronary syndrome (ACS). This study aimed to investigate the relationship between non-HDL-C levels and coronary artery disease extent in patients with ACS and assess its predictive value. Methods This cross-sectional study, conducted at the Affiliated Hospital of Zunyi Medical University, included 1,695 patients with ACS who underwent percutaneous coronary intervention (PCI) between May 1, 2019, and May 1, 2023. Patients were grouped based on non-HDL-C tertiles, as follows: T1 (non-HDL-C < 3.22, n = 577), T2 (3.22 ≤ non-HDL-C < 4.33, n = 553), and T3 (4.33 ≤ non-HDL-C index, n = 565). Coronary artery disease extent was quantitatively assessed using the Gensini score, categorised into low (< 50) and high groups (≥ 50) according to the median. The primary outcome was a high Gensini score. Results In the overall ACS population, multifactorial logistic regression (odds ratio [OR] = 1.20; 95% confidence interval [CI] = 1.10–1.31; P < 0.001), adjusted for potential risk factors, identified non-HDL-C as an independent risk factor for high Gensini scores. Subgroup analyses, adjusting for potential risk factors, revealed similar findings across sexes, ages (elderly or non-elderly), and DM status (diabetic or non-diabetic) among patients with ACS. Restrictive cubic spline analysis showed a dose-response relationship between non-HDL-C and high Gensini scores. Incorporating non-HDL-C into the baseline risk model had an incremental predictive effect on high Gensini scores in patients with ACS. Conclusions Non-HDL-C levels showed a dose-response relationship with coronary artery disease severity in patients with ACS, indicating predictive potential for coronary artery disease in this population.