Atherogenic index of plasma and non-traditional lipid parameters in coronary artery calcification: a Chinese health checkup study

Background Coronary artery calcification (CAC) is a reliable marker of subclinical atherosclerosis. Non-traditional lipid parameters, such as the atherogenic index of plasma (AIP), non-high density lipoprotein cholesterol (non-HDL-C), total cholesterol to high-density lipoprotein cholesterol (TC/HDL-C) ratio and remnant cholesterol (RC) are gaining attention for their association with cardiovascular risk. This study aimed to investigate the association of these non-traditional lipid parameters with CAC and their predictive value in a Chinese health checkup cohort. Methods In this retrospective cross-sectional study, 4196 adults who underwent health checkups at Jinling Hospital, Afliated Hospital of Medical School, Nanjing University, from January to December 2024 were enrolled. Participants were categorized into a non-calcification group (n = 3548) and a calcification group (n = 648) based on the presence of CAC detected by chest computed tomography. Demographic, clinical data, and lipid profiles were collected. Multivariable logistic regression analyses were used to evaluate the independent association between lipid parameters (including AIP, non-HDL-C, TC/HDL-C, RC, low-density lipoprotein cholesterol [LDL-C], and high-density lipoprotein cholesterol [HDL-C]) and CAC. Receiver operating characteristic (ROC) curve analysis and the area under the curve (AUC) were used to assess the discriminative ability of each parameter. Results Participants with CAC were older, more likely to be male, and had a higher burden of traditional cardiovascular risk factors. In multivariable logistic regression analyses adjusted for age, sex, blood pressure, body mass index, smoking, medical histories, and medications, AIP (odds ratio [OR] = 1.51, 95% confidence interval [CI]: 1.05–2.16, P = 0.025), non-HDL-C (OR = 1.23, 95% CI: 1.10–1.38, P < 0.001), and TC/HDL-C (OR = 1.09, 95% CI: 1.02–1.16, P = 0.006) remained significantly and positively associated with CAC. The association for RC became non-significant after full adjustment. ROC analysis revealed that AIP had the highest discriminative ability (AUC = 0.612, 95% CI: 0.589–0.635), followed by TC/HDL-C (0.597) and non-HDL-C (0.576), all of which performed better than traditional LDL-C (0.555) and HDL-C (0.574). Conclusion Among a Chinese health checkup cohort, the non-traditional lipid parameters AIP, non-HDL-C, and TC/HDL-C are independently associated with the presence of CAC. AIP demonstrates the best discriminative performance, suggesting it may be a promising biomarker for identifying individuals at high risk for coronary artery calcification.