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

Purpose: 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. Patients and Methods: 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). Results: 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). Conclusion: 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. Keywords: body mass index, BMI, high-density lipoprotein cholesterol, HDL-C, BMI/HDL ratio, coronary artery disease, CAD, risk stratification