Abstract
OBJECTIVE: To investigate the association between admission blood glucose and atypical angina in patients with coronary artery disease (CAD), and to investigate the risk factors associated with atypical angina in coronary heart disease. METHODS: A total of 729 patients who underwent coronary angiography at Xuancheng People’s Hospital between December 2018 and December 2024 were enrolled. According to clinical presentation during CAD onset, patients were classified into a typical angina group and an atypical angina group. Clinical variables including admission blood glucose levels, and monocyte-to-lymphocyte ratio (MLR) were collected and compared between groups. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for atypical angina in patients with CAD. Receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive value of admission blood glucose and diabetes status for atypical angina. Mediation analysis was conducted to assess the mediating role of admission blood glucose in the association between diabetes and atypical angina. Restricted cubic spline analysis was applied to characterize the dose–response relationship between admission blood glucose and atypical angina. RESULTS: Both univariate and multivariate logistic regression analyses demonstrated that a history of diabetes, elevated admission blood glucose, and increased MLR were independent risk factors for atypical angina in patients with CAD (all P < 0.05). ROC curve analysis indicated that history of diabetes and admission blood glucose exhibited modest predictive value for the occurrence of atypical angina in CAD patients (P < 0.05). Mediation analysis revealed that admission blood glucose significantly mediated the association between diabetes and atypical angina. Furthermore, restricted cubic spline analysis showed a significant linear relationship between admission blood glucose levels and the risk of atypical angina. CONCLUSIONS: Admission blood glucose, a history of diabetes, and MLR are independently associated with the occurrence of atypical angina in patients with CAD. Admission blood glucose plays a significant mediating role in the relationship between diabetes and atypical angina. Both admission blood glucose and diabetes history demonstrate modest predictive value for atypical angina, suggesting their potential utility as early warning indicators in patients with CAD. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12872-026-05712-0.