Abstract
OBJECTIVE: To explore the relationship between the triglyceride-glucose index (TyG), the monocyte to high-density lipoprotein cholesterol ratio (MHR) and the severity of coronary artery disease (CAD) under different glucose metabolism states. METHODS: A retrospective analysis was conducted on 526 patients who underwent coronary angiography (CAG) for the first time in the Affiliated Hospital of Xuzhou Medical University from January 2024 to January 2025. Among them, there were 122 patients in the non-CAD group and 404 patients in the CAD group. According to the Gensini score, the CAD group was further divided into a mild group (n = 147) and a moderate-to-severe group (n = 257). Meanwhile, they were divided into normal glucose regulation (NGR), prediabetes (Pre-DM), and diabetes mellitus (DM) groups according to the glucose metabolism state. Multivariate Logistic regression, restricted cubic spline (RCS), and receiver operating characteristic (ROC) curve analyses were used. RESULTS: Both the TyG index and MHR were independent risk factors for the occurrence and severity of CAD (P<0.05). In the DM group, the TyG index was significantly associated with the severity of CAD (OR=4.30, 95% CI: 1.48-12.49, P<0.01); in the NGR group, MHR was significantly associated with the severity of CAD (OR=436.1, 95% CI: 15.4-12342, P<0.001). RCS analysis suggested a significant linear positive correlation between the TyG index and the severity of CAD (P-overall=0.006, P-non-linear=0.917), while there was a non-linear relationship between MHR and the severity of CAD (P-overall=0.007, P-non-linear=0.033). ROC analysis showed that the area under the curve (AUC) of the combined prediction was 0.655, higher than that of the TyG index (0.618) and MHR (0.631). CONCLUSION: TyG index and MHR can serve as independent biomarkers of new-onset CAD severity. In DM patients, TyG offers greater predictive value, while MHR is more predictive in NGR individuals.