Metabolic, Atherogenic, and Anthropometric Markers for Discrimination of Premature Coronary Artery Disease in a Predominantly Statin-Treated Cohort.
- 1Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
- 2Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
Abstract
Purpose
Premature coronary artery disease (PCAD) is increasingly recognized in younger adults and requires improved risk stratification. Conventional lipid markers may have limited discriminative value, particularly when lipid levels reflect ongoing statin therapy. This study evaluated the associations and discriminatory performance of metabolic, atherogenic, and anthropometric indices for PCAD and developed internally validated dynamic nomograms for PCAD case discrimination.Patient and methods
This multicenter retrospective case-control study used data from the Iran Premature Coronary Artery Disease registry. A total of 3063 adults undergoing coronary angiography were included, comprising 1929 patients with PCAD and 1134 controls. Twelve metabolic, lipid-based, and anthropometric indices were calculated from fasting glucose, lipid profiles, and body measurements. Participants were randomly divided into training and validation cohorts at a 7:3 ratio. Logistic regression, receiver operating characteristic analysis, calibration assessment, integrated discrimination improvement, net reclassification improvement, and decision-curve analysis were used to evaluate model performance.Results
Atherogenic index of plasma (AIP), triglyceride-glucose index (TyG), and a body shape index (ABSI) showed consistent independent associations with PCAD. Individually, these indices showed modest discrimination. The conventional clinical model achieved an AUC of 0.677. Adding AIP and binary ABSI increased the AUC to 0.721, while the TyG plus binary ABSI model showed the highest performance, with an AUC of 0.724, representing modest but statistically significant improvements over the conventional model. Both final models showed favorable internal calibration, and improvement in reclassification metrics, and decision-curve net benefit. Two dynamic web-based nomograms were developed for individualized PCAD case discrimination.Conclusion
TyG, AIP, and ABSI were independently associated with PCAD and provided modest incremental discrimination beyond conventional risk factors in this predominantly statin-treated case-control cohort. The resulting dynamic nomograms provide an accessible framework for PCAD case discrimination; however, their clinical applicability and estimation of absolute risk require external validation in independent, preferably prospective, populations.
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BibTeX
@article{mirzohreh2026metabolic,
title = {{Metabolic, Atherogenic, and Anthropometric Markers for Discrimination of Premature Coronary Artery Disease in a Predominantly Statin-Treated Cohort.}},
author = {Seyedeh-Tarlan Mirzohreh and Samad Ghaffari and Elnaz Javanshir and Mahshid Dehghan and Faezeh Tarighat and Noushin Mohammadifard and Nizal Sarrafzadegan and Neda Roshanravan and Ehsan Zarepur},
journal = {Vascular health and risk management},
year = {2026},
month = oct,
doi = {10.2147/vhrm.s630288},
url = {https://europepmc.org/article/MED/42904224},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Metabolic, Atherogenic, and Anthropometric Markers for Discrimination of Premature Coronary Artery Disease in a Predominantly Statin-Treated Cohort.
AU - Seyedeh-Tarlan Mirzohreh
AU - Samad Ghaffari
AU - Elnaz Javanshir
AU - Mahshid Dehghan
AU - Faezeh Tarighat
AU - Noushin Mohammadifard
AU - Nizal Sarrafzadegan
AU - Neda Roshanravan
AU - Ehsan Zarepur
PY - 2026
DA - 2026/10/16
JO - Vascular health and risk management
DO - 10.2147/vhrm.s630288
UR - https://europepmc.org/article/MED/42904224
AB - Purpose Premature coronary artery disease (PCAD) is increasingly recognized in younger adults and requires improved risk stratification. Conventional lipid markers may have limited discriminative value, particularly when lipid levels reflect ongoing statin therapy. This study evaluated the associations and discriminatory performance of metabolic, atherogenic, and anthropometric indices for PCAD and developed internally validated dynamic nomograms for PCAD case discrimination.Patient and methods This multicenter retrospective case-control study used data from the Iran Premature Coronary Artery Disease registry. A total of 3063 adults undergoing coronary angiography were included, comprising 1929 patients with PCAD and 1134 controls. Twelve metabolic, lipid-based, and anthropometric indices were calculated from fasting glucose, lipid profiles, and body measurements. Participants were randomly divided into training and validation cohorts at a 7:3 ratio. Logistic regression, receiver operating characteristic analysis, calibration assessment, integrated discrimination improvement, net reclassification improvement, and decision-curve analysis were used to evaluate model performance.Results Atherogenic index of plasma (AIP), triglyceride-glucose index (TyG), and a body shape index (ABSI) showed consistent independent associations with PCAD. Individually, these indices showed modest discrimination. The conventional clinical model achieved an AUC of 0.677. Adding AIP and binary ABSI increased the AUC to 0.721, while the TyG plus binary ABSI model showed the highest performance, with an AUC of 0.724, representing modest but statistically significant improvements over the conventional model. Both final models showed favorable internal calibration, and improvement in reclassification metrics, and decision-curve net benefit. Two dynamic web-based nomograms were developed for individualized PCAD case discrimination.Conclusion TyG, AIP, and ABSI were independently associated with PCAD and provided modest incremental discrimination beyond conventional risk factors in this predominantly statin-treated case-control cohort. The resulting dynamic nomograms provide an accessible framework for PCAD case discrimination; however, their clinical applicability and estimation of absolute risk require external validation in independent, preferably prospective, populations.
SN - 1176-6344
SN - 1178-2048
ER -