Abstract
BACKGROUND: Coronary atherosclerosis is a leading cause of coronary heart disease (CHD), particularly among postmenopausal women who experience significant hormonal changes that influence lipid metabolism and inflammatory processes. We aimed to investigate the correlation between monocyte-to-HDL-cholesterol ratio (MHR), estradiol and the severity of coronary lesions in postmenopausal patients with CHD. METHODS: This study included 360 postmenopausal women diagnosed with CHD. The Gensini score (GS) was obtained from coronary angiography, and patients were divided into three groups according to the severity of coronary lesions assessed by GS - patients with mild coronary lesions (Gensini score < 20), patients with moderate coronary lesions (20 ≤ Gensini score < 40) and patients with severe coronary lesions (Gensini score ≥ 40). We used ordinal logistic regression to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for the association between estradiol, MHR, and coronary lesion severity. For assessing the value of estradiol and MHR in predicting the severity of CHD, we adopted the generalized area under the receiver operating characteristic (ROC) curve method. RESULTS: The severe lesion group had the lowest estradiol levels and the highest MHR (all p < 0.001). MHR showed a weaker negative correlation with estradiol levels. After adjusting for confounding factors, estradiol was significantly negatively correlated with the severity of CHD (OR = 0.93, 95%CI = 0.91-0.96), while MHR was significantly positively correlated with the severity of CHD (OR = 1.15, 95%CI = 1.01-1.29). Interaction analysis showed significant interaction between estradiol levels and MHR (p < 0.001). The area under the curve (AUC) of MHR and estradiol in predicting the severity of CHD in postmenopausal women for the ROC analysis was 0.806 (95%CI = 0.745-0.866) and 0.661 (95%CI = 0.592-0.730), respectively. The AUC of MHR combined with estradiol was 0.826 (95%CI = 0.774-0.877). CONCLUSION: Both estradiol and MHR are independently correlated with and can be used to predict the severity of CHD in postmenopausal women. The combination of estradiol and MHR has a higher predictive value for the severity of CHD. CLINICAL TRIAL NUMBE: Not applicable.