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Elevated total cholesterol to high-density lipoprotein cholesterol ratio as a novel predictor of coronary slow flow

Xin-Tong Dai1, Tian-Zhong Kong2, Ai-Jie Hou2

  • 1Department of Cardiology, Chest Hospital, Tianjin University, Tianjin, P.R. China.

Acta Cardiologica
|May 20, 2026
PubMed

Insights

A high total cholesterol to high-density lipoprotein cholesterol (TC/HDL-C) ratio is linked to coronary slow flow (CSF). This elevated ratio may help predict the presence of CSF in patients.

Area of Science:

  • Cardiology
  • Atherosclerosis Research
  • Lipid Metabolism

Background:

  • Inflammation and atherosclerosis are key factors in coronary slow flow (CSF) development.
  • A high total cholesterol to high-density lipoprotein cholesterol (TC/HDL-C) ratio correlates with atherosclerosis, inflammation, and adverse cardiovascular outcomes.
  • The TC/HDL-C ratio's association with CSF requires further investigation.

Purpose of the Study:

  • To investigate the relationship between the TC/HDL-C ratio and the presence of coronary slow flow (CSF).
  • To determine if the TC/HDL-C ratio can serve as a predictor for CSF.

Main Methods:

  • Retrospective study including 107 patients with angiographically confirmed CSF and 196 controls.
  • Coronary flow velocity assessed using the thrombolysis in myocardial infarction (TIMI) frame count (TFC).
  • Lipid parameters measured to calculate the TC/HDL-C ratio for all participants.

Main Results:

  • Patients with CSF exhibited a significantly higher TC/HDL-C ratio compared to the control group.
  • Receiver operating characteristic (ROC) curve analysis indicated the TC/HDL-C ratio possesses superior predictive value for CSF compared to total cholesterol alone.

Conclusions:

  • The TC/HDL-C ratio demonstrates a strong association with the presence of coronary slow flow (CSF).
  • An elevated TC/HDL-C ratio may function as a valuable predictor for identifying individuals with CSF.
Abstract

Keywords:
Coronary slow flowcoronary atherosclerosishigh-density lipoprotein cholesteroltotal cholesterol

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