Abstract
The platelet to high-density lipoprotein cholesterol ratio (PHR) serves as a novel marker reflecting systemic inflammation and lipid metabolism. However, the correlation between PHR and coronary artery lesions severity in middle-aged and elderly individuals remains unclear. Looking into the relationship between PHR and coronary artery lesions severity was the focus of this investigation in middle-aged and elderly individuals. A total of 1721 hospitalized middle-aged and elderly patients with coronary artery disease (aged ≥ 45years) were included in this investigation. PHR was calculated as platelet (10(9)/L)/high-density lipoprotein (mmol/L); Individuals have been categorized into four groups referring to PHR quartiles. The severity of coronary artery lesions was assessed using the number of diseased vessels and the Gensini scores. Clinical and laboratory data were screened using least absolute shrinkage and selection operator (LASSO) regression; Receiver operating characteristic (ROC) curves were generated to assess the predictive value of PHR for the severity of coronary lesions. Spearman correlation coefficients and heatmaps were then employed to explore the correlation between PHR and baseline variables. Furthermore, multivariate logistic regression models and restricted cubic spline models were constructed to employ the association between PHR and coronary lesion severity in middle-aged and elderly individuals; Subgroup and interaction analyses were performed for further analysis. PHR showed a strong predictive performance for coronary lesion severity (AUC = 0.8126). Higher PHR levels were significantly associated with increased coronary lesion severity. Individuals in the highest quartile of PHR exhibited significantly more severity of coronary lesions than those in the lowest quartile (adjusted Q4: OR = 1.342, 95% CI = 1.100-1.638, P = 0.004). The association was more pronounced in females (adjusted Q4: OR = 1.422, 95% CI:1.043–1.940, P = 0.026). but not significant in males (adjusted Q4: OR = 1.229, 95% CI:0.958–1.576, P = 0.105). A linear dose–response relationship was confirmed using restricted cubic spline models (P-overall = 0.00935, P-linear = 0.0199). Interaction analysis showed consistent associations across subgroups (all P for interaction > 0.05). PHR is a somewhat consistent measure of inflammation, showing a significant positive correlation with the severity of coronary artery disease. PHR can be utilized as a novel inflammatory index to estimate coronary artery disease in middle-aged and elderly individuals. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1038/s41598-025-12981-w.