Risk factors for coronary artery ectasia and the relationship between hyperlipidemia and coronary artery ectasia

Coronary artery ectasia (CAE) is the aneurysmal dilatation of the coronary artery, recognized as a special clinical form of coronary stenosis besides atherosclerosis. Its exact pathophysiological mechanism remains unknown. Moreover, few studies have focused on the relationship between triglyceride and CAE. We aimed to find the risk factors for CAE and analyze the relationship between serum lipid and CAE.

We conducted a prospective cohort study on patients admitted because of typical or atypical chest discomfort suggestive of angina in Zhongda Hospital affiliated to Southeast University from January 2010 to June 2018. We included 100 consecutive patients with CAE; the control group included 100 consecutive patients with coronary atherosclerosis and no ectasia. We recorded and compared the general data, cardiovascular risk factors, blood examination index, and coronary angiography data between the two groups. t-Test, Mann-Whitney U-test, χ-test, logistic regression analysis, and receiver operating characteristic curve analysis were used for statistical analysis to assess the risk factors for CAE and analyze the relationship between hyperlipidemia and CAE.

Sex, weight, BMI, diastolic blood pressure, hypertension, hemoglobin, D-dimer, triglyceride, total cholesterol, and low-density lipoprotein/high-density lipoprotein (LDL/HDL) ratio were significantly higher in the CAE group than in the control group (P=0.0028, 0.001, <0.001, <0.001, 0.008, <0.001, 0.050, <0.001, 0.043, and 0.004, respectively). Logistic regression analysis showed that sex, BMI, diastolic blood pressure, D-dimer, triglyceride, and LDL/HDL ratio were independent risk factors for CAE [odds ratio (OR)=2.076, 95% confidence interval (CI)=1.232-2.673, P=0.016; OR=1.184, 95% CI=1.607-1.436, P<0.001; OR=1.177, 95% CI=1.026-1.264, P=0.007; OR=1.004, 95% CI=1.002-1.007, P=0.019; OR=3.736, 95% CI=2.028-6.883, P<0.001; and OR=1.569, 95% CI=1.229-2.419, P=0.026, respectively]. The receiver operating characteristic curve for the model combining triglyceride with LDL/HDL ratio for predicting CAE showed an area under the curve of 0.706 and 95% CI of 0.634-0.778 (P<0.001). Sex, BMI, diastolic blood pressure, D-dimer, and triglyceride combined with LDL/HDL ratio have a better predictive value for CAE (area under the curve=0.898, 95% CI=0.849-0.947, P<0.001).

Sex, BMI, diastolic blood pressure, D-dimer, triglyceride, and LDL/HDL ratio are all risk factors for CAE. Hyperlipidemia has a good predictive value for CAE.