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Evaluating Body Mass Index to High-Density Lipoprotein Cholesterol (BMI/HDL-C) Ratio in Predicting Coronary Artery
Himayat Ullah1, Sarwat Huma2,3, Nafisa Tahir4
1Department of Medicine, College of Medicine at Shaqra, Shaqra University, Shaqra, Saudi Arabia.
Insights
The body mass index to high-density lipoprotein cholesterol ratio (BMI/HDL-C) effectively identifies coronary artery disease (CAD) risk. This simple marker shows superior discrimination for CAD compared to BMI or HDL-C alone.
Area of Science:
- Cardiology
- Biomarkers
- Risk Assessment
Background:
- Coronary artery disease (CAD) risk stratification benefits from accessible markers combining adiposity and lipoprotein status.
- Existing markers like body mass index (BMI) and high-density lipoprotein cholesterol (HDL-C) have limitations in discriminating CAD risk.
Purpose of the Study:
- To evaluate the body mass index to high-density lipoprotein cholesterol ratio (BMI/HDL-C) as a potential marker for discriminating angiographically confirmed CAD.
- To compare the discriminatory ability of BMI/HDL-C against BMI and HDL-C alone.
Main Methods:
- A multicenter observational study involving 834 adults undergoing coronary angiography.
- Measurement of BMI and fasting HDL-C, calculation of BMI/HDL-C ratio.
- Statistical analyses included Spearman correlation, logistic regression, and receiver operating characteristic (ROC) analysis with Area Under the Curve (AUC) to assess CAD discrimination.
Main Results:
- The BMI/HDL-C ratio showed the strongest correlation with CAD (rho = 0.68).
- Logistic regression indicated that increased BMI/HDL-C ratio significantly increased CAD odds (55.2% per unit increase).
- ROC analysis revealed superior CAD discrimination for BMI/HDL-C (AUC 0.892) compared to HDL-C (AUC 0.875) and BMI (AUC 0.582), with statistically significant differences (p < 0.001).
Conclusions:
- The BMI/HDL-C ratio demonstrates superior discriminatory power for angiographically defined CAD compared to BMI or HDL-C individually.
- The BMI/HDL-C ratio is a promising simple and clinically useful marker for CAD risk assessment.
- Further validation in prospective studies is recommended to confirm its clinical utility.
Purpose:
The purpose of the study is to search for simple, widely available markers that combine adiposity and lipoprotein status to improve coronary artery disease (CAD) risk discrimination. For this, we evaluated whether the body mass index to high-density lipoprotein cholesterol ratio (BMI/HDL-C) discriminates angiographically confirmed CAD better than BMI or HDL-C alone.
Patients And Methods:
In this multicenter observational study, we enrolled 834 adults undergoing coronary angiography at three tertiary centers. CAD was defined as ≥50% stenosis in ≥1 major coronary artery and its branches. BMI and fasting HDL-C were measured on admission; BMI/HDL-C was calculated. We assessed associations using Spearman correlation, logistic regression, receiver operating characteristic (ROC) analysis, and Area under the curve (AUC).
Results:
Mean age was 58.5 ± 11.9 years; 53.7% were male; 440 had CAD. BMI/HDL-C correlated most strongly with CAD (rho = 0.68) versus HDL-C (rho = -0.65) and BMI (rho = 0.142). In logistic regression (after adjusting for Diabetes Mellitus, Hypertension, dyslipidemia, and smoking), a one-unit increase in the HDL-C was associated with a 26.2% reduction in the odds of CAD, while a 6.4% and 55.2% increase in the odds of CAD was noted with a one-unit increase in the BMI and BMI/HDL ratio, respectively. ROC analysis showed superior discrimination for BMI/HDL-C (AUC 0.892; 95% CI 0.870-0.913) compared with HDL-C (AUC 0.875; 95% CI 0.849-0.901) and BMI (AUC 0.582; 95% CI 0.543-0.621). An optimal BMI/HDL-C cutoff of 19.7 achieved 100% sensitivity and 83.5% specificity. AUC differences were statistically significant (p < 0.001).
Conclusion:
In conclusion, the BMI/HDL-C ratio demonstrated superior discriminatory ability for angiographically defined CAD compared to BMI or HDL-C alone, suggesting its potential as a simple and clinically useful marker, although further validation in prospective studies is warranted.
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