Prognostic value of non-traditional lipid parameters: Castelli Risk Index I, Castelli Risk Index II, and triglycerides to high-density lipoprotein cholesterol ratio among patients with non-ST-segment elevation myocardial infarction during 1‑year follow-up

Abstract

Aim Concentrations of classical lipoproteines have a well-established role in non-invasive cardiology. The efficacy of the Castelli Risk Index I (CRI I), Castelli Risk Index II (CRI II), and triglycerides to high-density lipoprotein cholesterol (TG / HDL-C) ratio in clinical practice are currently under evaluation. The study aimed to assess the predictive value of CRI I, CRI II and TG / HDL-C for the incidence of Major Adverse Cardiovascular Events (MACE) and for all-cause mortality during 1‑year follow-up of patients with non-ST-segment elevation myocardial infarction (NSTEMI).Material and Methods 1,301 patients were enrolled in the study. Associations between CRI I, CRI II, TG / HDL-C and occurrence of MACE and 1‑year mortality were studied. Moreover correlations between CRI I, CRI II, and TG / HDL-C and the severity of coronary artery disease (CAD) were assessed.Results MACE occurred in 10.9 % (142) of patients, and 1‑year mortality was 13.4 % (174). None of the evaluated indices appeared to be an independent predictor of MACE in either the entire population or subpopulations, as divided according to the presence of diabetes or CAD diagnosed prior to admission. Furthermore, no dependence between 1‑year mortality and the examined indices was found. Additionally, only a weak correlation between CAD severity and CRI I was observed (R=0.08, p=0.02). No significant correlations for CRI II (p=0.07) and TG / HDL-C (p=0.6) were detected.Conclusions CRI I, CRI II and TG / HDL-C should not be used as predictors of MACE or all-cause mortality among patients with NSTEMI. Moreover, these indices do not reflect CAD severity.

Relationship between the Castelli risk indeces and the presence and severity of ischemia in non-geriatric patients with suspected coronary artery disease

“…Although these findings support that CRI can be an important screening tool in predicting CAD, there are studies reporting the opposite. In a study conducted with non-ST-segment elevation myocardial infarction patients, it was reported that there was a low correlation between CAD severity and CRI-I, but CRI-II did not show a significant relationship [19]. On the other hand, previous studies have reported a positive correlation between the myocardial damage and extent of CAD [20][21][22].…”

Association of atherosclerosis indices, serum uric acid to high‐density lipoprotein cholesterol ratio and triglycerides‐glucose index with hypertension: A gender‐disaggregated analysis

“…CRI I and CRI II were initially proposed by Castelli and colleagues as strong predictors of coronary artery disease 53 . Both Castelli indices showed statistical significance for predicting peripheral arterial disease, intracranial atherosclerotic stenosis, and cardiovascular risk in men 14 . CRI I reflects the formation of coronary plaques with a diagnostic value as good as the determination of total cholesterol and is consistently associated with arterial stiffness in a range of LDL‐C levels, even if LDL‐C is below 70 mg/dL 54 .…”

“…[7][8][9] However, it has been argued that reliance on LDL-C or HDL-C alone is not adequate and the combination of multiple lipid parameters and unconventional lipid indices is a more reliable and accurate risk than simple lipid parameters in disease prediction, especially when the conventional lipid parameters are apparently normal or moderately high. 10,11 These unconventional lipid ratios, which are called atherosclerosis indices, include: atherogenic coefficient (AC), Castelli's risk index I (CRI I) and II (CRI II), atherogenic index of plasma (AIP), and non-HDL-C. 10,[12][13][14] The triglyceride-glucose (TyG) index, fasting blood glucose (FBG) and triglyceride synthesis parameter has been proposed as an important risk marker to evaluate insulin resistance and CVD risk. 15 According to reports, insulin resistance is implicated in the pathogenic processes of arterial hypertension by its effect on endothelial function, renal sodium metabolism, sympathetic nerve system activation, and modulation of vasoactive substances secretion.…”

“…However, it has been argued that reliance on LDL‐C or HDL‐C alone is not adequate and the combination of multiple lipid parameters and unconventional lipid indices is a more reliable and accurate risk than simple lipid parameters in disease prediction, especially when the conventional lipid parameters are apparently normal or moderately high 10,11 . These unconventional lipid ratios, which are called atherosclerosis indices, include: atherogenic coefficient (AC), Castelli's risk index I (CRI I) and II (CRI II), atherogenic index of plasma (AIP), and non‐HDL‐C 10,12–14 …”

“… 10 , 11 These unconventional lipid ratios, which are called atherosclerosis indices, include: atherogenic coefficient (AC), Castelli's risk index I (CRI I) and II (CRI II), atherogenic index of plasma (AIP), and non‐HDL‐C. 10 , 12 , 13 , 14 …”