Association between non-high-density lipoprotein cholesterol and coronary artery disease in patients with acute coronary syndrome: a single-centre retrospective cross-sectional analysis

Background A significant relationship exists between atherosclerotic cardiovascular disease (ASCVD) and non-high-density lipoprotein cholesterol (non-HDL-C). However, the relationship between non-HDL cholesterol levels and coronary artery disease in patients with acute coronary syndrome (ACS) remains under-researched and poorly understood. Therefore, this study aimed to explore the association between non-HDL-C and coronary artery disease in individuals with ACS. Methods This single-centre retrospective cross-sectional study included 1695 patients with ACS who underwent percutaneous coronary intervention at Zunyi Medical University's Affiliated Hospital from May 2019 to May 2023. The patients were categorised into three groups based on non-HDL cholesterol tertiles. The severity of coronary artery disease was assessed using the Gensini score, and patients were categorised into high and low Gensini score groups. Logistic regression models, including multifactorial adjustments, were used to analyse the association between non-HDL-C levels and high Gensini scores. Results After adjusting for potential risk factors, multifactorial logistic regression (odds ratio [OR] = 1.20; 95% confidence interval [CI] = 1.10–1.31; p  < 0.001) revealed that non-HDL-C was an independent risk factor for high Gensini scores. After subgrouping based on age, sex, and glucose metabolic status, non-HDL-C remained an independent risk factor for high Gensini scores in these subgroups. Restricted cubic spline analysis revealed that a higher non-HDL-C level was associated with a greater the risk of having a high Gensini score. Receiver operating characteristic curve analysis revealed that non-HDL-C was incrementally predictive of high Gensini scores in patients with ACS. Conclusions Non-HDL-C is dose-dependently associated with the severity of coronary artery disease in patients with ACS. These findings suggest the potential of non-HDL-C in predicting its severity, supporting its use as a cost-effective and accessible marker for assessing coronary artery disease risk.