Association of the cholesterol-high-density lipoprotein-glucose index with coronary atherosclerotic burden in patients with coronary artery disease

Abstract

Background The cholesterol-high-density lipoprotein-glucose (CHG) index is a novel composite metabolic marker, but its association with coronary atherosclerotic burden in patients with coronary artery disease (CAD) remains unclear. This study aimed to investigate the association between the CHG index and the Gensini score in patients with CAD. Methods We included patients with CAD admitted between January 2024 and January 2025. Multivariable linear regression and restricted cubic spline (RCS) analyses were performed to evaluate the association and dose–response relationship between the CHG index and log-transformed (Gensini score + 1). Subgroup and sensitivity analyses assessed the robustness of the findings. Receiver operating characteristic (ROC) curve analysis was used to evaluate discriminative ability for identifying high coronary atherosclerotic burden. Net reclassification improvement (NRI), integrated discrimination improvement (IDI), and decision curve analysis (DCA) were used to assess the incremental value of the CHG index. Results A total of 758 participants were included. In the fully adjusted model, each 1-SD increase in the CHG index was associated with a 0.121-unit increase in log-transformed (Gensini score + 1) (β = 0.121, 95% CI, 0.036–0.205, p = 0.005). RCS analysis further indicated an approximately linear dose–response relationship. Quartile-based analyses showed an overall positive gradient. The association was directionally consistent across subgroups, with no significant interactions, despite not reaching statistical significance in some strata. Sensitivity analyses yielded consistent results. Among the metabolic markers evaluated, the CHG index had the numerically highest standalone AUC, although its discriminative ability was modest (AUC = 0.603). Adding the CHG index to the basic model slightly increased the AUC from 0.652 to 0.667, without a statistically significant difference (DeLong p = 0.168), but significantly improved continuous NRI (0.135, p = 0.042) and IDI (0.016, p = 0.002). DCA indicated a modest net benefit over a limited range of intermediate threshold probabilities. Conclusion A higher CHG index was associated with a higher Gensini score in patients with CAD. As a simple and inexpensive metabolic marker, the CHG index may provide complementary information for assessing coronary atherosclerotic burden. However, its clinical utility requires further evaluation in prospective studies incorporating external validation and longitudinal clinical outcomes.