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Yushan Shi

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Open access Aug 2026

Association between hemoglobin-to–HDL cholesterol ratio and long-term major adverse cardiovascular events in STEMI patients undergoing PCI

Residual cardiovascular risk remains high in patients with ST-segment elevation myocardial infarction (STEMI) despite successful primary percutaneous coronary intervention (PCI). Hemoglobin and high-density lipoprotein cholesterol (HDL-C) are routinely measured biomarkers reflecting oxygen delivery and cardiometabolic status, respectively. Whether the hemoglobin-to–HDL cholesterol ratio (Hb/HDL ratio) is associated with prognosis in patients with STEMI undergoing PCI remains unknown. We evaluated the association between the Hb/HDL ratio and long-term major adverse cardiovascular events (MACE) in patients with STEMI. A total of 462 consecutive patients with STEMI undergoing primary PCI were included (median follow-up, 30 months). The primary endpoint was a composite of MACE. The Hb/HDL ratio was modeled continuously (per 1-SD increment) and categorically (by tertiles). Time-to-event analyses were performed using Kaplan–Meier analysis and multivariable Cox proportional hazards regression. Dose–response relationships and exploratory incremental prognostic performance were evaluated using restricted cubic spline analysis and time-dependent ROC, IDI, and continuous NRI. During 30 months of follow-up, 118 patients (25.5%) developed MACE. Kaplan–Meier curves showed significantly lower MACE-free survival in the lowest Hb/HDL tertile(log-rank P = 0.002). In multivariable-adjusted Cox models, each 1-SD increment in the Hb/HDL ratio was associated with a 26% lower risk of MACE (HR 0.74, 95% CI 0.59–0.93; P = 0.009). This association remained unchanged after additional adjustment for peak cardiac troponin I (HR 0.74, 95% CI 0.59–0.92; P = 0.008). Compared with the lowest tertile, both the second and third tertiles were associated with reduced risks (HR 0.56 and 0.61, respectively; P for trend = 0.023). RCS analysis showed an inverse association between the Hb/HDL ratio and MACE, with no evidence of nonlinearity (P for overall association = 0.017; P for nonlinearity = 0.232). Results were consistent across most subgroups, except for a significant interaction with apelin levels (P for interaction = 0.033). Higher Hb/HDL ratio was independently and linearly associated with a lower long-term risk of MACE in STEMI patients undergoing PCI. Given its routine availability in clinical practice, the Hb/HDL ratio may serve as a simple adjunctive marker for long-term risk stratification following primary PCI.

Cheng Chang, Xuechuan Dan, Ronglu Jiang et al. · BMC Cardiovascular Disorders · 0 citations

Open access Aug 2026

Association between the C-reactive protein-albumin-lymphocyte index and incident depression in patients with chronic obstructive pulmonary disease: a prospective cohort study from the UK biobank

Depression is a prevalent and underrecognized comorbidity in chronic obstructive pulmonary disease (COPD) that worsens outcomes. The C-reactive protein–albumin–lymphocyte (CALLY) index, a composite immune-nutritional biomarker, has demonstrated prognostic value in various chronic conditions, but its prospective association with incident depression in COPD remains unexplored. This prospective cohort study included 40,200 UK Biobank participants with baseline COPD. Cox proportional hazards regression was used to estimate the association between the CALLY index and incident depression, with progressive adjustment across five models. Restricted cubic spline (RCS) curves and two-segment Cox regression was applied to characterize non-linear associations and identify inflection points. Subgroup and sensitivity analyses were conducted to assess robustness. During a mean follow-up of 13.1 ± 2.8 years, 2,059 incident depression events occurred. In the fully adjusted model, each one-standard deviation (SD) increment in ln-CALLY was associated with a 7% lower risk of depression (HR = 0.93, 95% CI: 0.88–0.97, P = 0.002). The highest quartile exhibited an 18% risk reduction vs. the lowest (HR = 0.82, 95% CI: 0.72–0.95, P = 0.007). RCS analysis revealed a significant L-shaped relationship ( P for non-linearity = 0.022). Threshold effect analysis identified an inflection point at CALLY = 17.75; below this threshold, each one-unit increase was associated with a 5% risk reduction (HR = 0.95, 95% CI: 0.90–0.99, P = 0.037), whereas above the threshold the association was non-significant. A nominally significant age interaction was observed ( P = 0.017), though this did not survive Bonferroni correction for multiple testing (adjusted threshold P < 0.007). Sensitivity analyses including Fine-Gray competing risk models yielded consistent results. In COPD patients, the CALLY index exhibits a significant L-shaped association with incident depression risk, characterized by a pronounced protective effect below the identified threshold and a risk plateau above it. These findings suggest that the CALLY index may serve as a clinically accessible tool for depression risk stratification, particularly in younger COPD patients, although the age-specific effect requires confirmation in future studies.

Yushan Shi, Xianhai Chen, Yan Wang · Frontiers in Medicine · 0 citations