Atherogenic index as an associative marker for coronary artery disease

Coronary artery disease (CAD) is a significant global health burden, warranting pragmatic, low-cost biomarkers for effective risk stratification. The atherogenic index of plasma (AIP), calculated as log(TG/HDL-C), is a lipid-derived indicator of cardiometabolic risk. We evaluated AIP as an associative marker for CAD and compared its diagnostic performance with commonly used biomarkers.

In a hospital-based, angiography-confirmed case-control cohort (n = 340; 211 cases, 129 controls), we assessed AIP alongside uric acid, creatinine, neutrophil-to-lymphocyte ratio (NLR), TG/HDL‑C, HbA1c, and ejection fraction. Group characteristics were summarized using descriptive statistics, chi-square tests, and ANOVA. Associations with CAD were examined using multivariable logistic regression adjusted for age, sex, body mass index, diabetes, hypertension, smoking status, and statin use. Discriminative performance was evaluated via receiver operating characteristic (ROC) analysis, with pairwise comparisons conducted using DeLong's test.

Values of AIP (OR 1.42, 95% CI 1.18-1.69; p = 0.012), uric acid (OR 1.20, 95% CI 1.02-1.42; p = 0.032), and creatinine (OR 1.69, 95% CI 1.03-2.76; p = 0.038) were independently associated with CAD. HbA1c, TG/HDL‑C, NLR, and ejection fraction were not significantly associated in multivariable models. Values of AIP increased with greater angiographic severity. In ROC analysis, AIP showed superior discriminatory ability to uric acid, creatinine, NLR, and HbA1c (all p < 0.05, DeLong test), and performed comparably to TG/HDL‑C, consistent with AIP being its log transformation.

Readily available AIP offers incremental prognostic value in symptomatic patients with suspected CAD. These findings are hypothesis-generating; thus, thresholds should be interpreted cautiously pending prospective, multicenter studies.