ArticleBMC cardiovascular disorders2026
Combined value of AIP and NHR for identifying obstructive coronary heart disease in premature cases with zero calcium.
Article in BMC cardiovascular disorders, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundA coronary artery calcium (CAC) score of zero is generally considered a strong negative predictor for coronary heart disease (CHD). However, it does not exclude obstructive disease in symptomatic adults, particularly younger patients with non-calcified plaque. We evaluated whether Atherogenic Index of Plasma (AIP) and Neutrophil-to-HDL Ratio (NHR) improve identification of obstructive CHD in this population.
methodsWe analyzed 362 symptomatic adults with suspected premature CHD (men < 55, women < 65 years) and CAC = 0 from an invasive angiography registry. AIP and NHR were calculated from fasting laboratory tests. The endpoint was angiographic obstructive CHD (≥ 50% stenosis).
resultsObstructive CHD occurred in 115/362 (31.8%). Adding AIP to traditional risk factors improved discrimination (area under the curve [AUC] 0.798 to 0.814) and model fit (Akaike information criterion [AIC] 337.8 to 333.1); adding NHR provided incremental improvement (AIC 331.6, AUC 0.818). Using internally derived cutoffs (AIP > 0.13, NHR > 3.08), the dual-high phenotype was associated with higher odds of obstructive CHD (odds ratio [OR] 4.59, 95% confidence interval [CI] 1.90–11.07, P < 0.001) compared with the low AIP/low NHR group.
conclusionIn symptomatic adults with suspected premature CHD and CAC = 0, the dual-high phenotype (elevated AIP and NHR) identifies a higher-risk subgroup for non-calcified obstructive disease. These findings underscore the limitations of CAC scoring alone in this population.
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