Key result
Elevated PHR levels combined with T2DM were associated with a 16% lower risk of MACEs compared to higher PHR in diabetic patients, with an aHR of 0.83 (95% CI: 0.73–0.96).
Why the study?
The association between platelet-to-HDL-cholesterol ratio (PHR) and glycemic metabolism status, and their combined prognostic effects in CAD patients undergoing PCI, remained unclear.
Does the combination of elevated platelet-to-HDL-cholesterol ratio and type 2 diabetes mellitus increase the risk of major adverse cardiovascular events in patients undergoing percutaneous coronary intervention?
Cohort (n=31,761)
No
Does the combination of elevated platelet-to-HDL-cholesterol ratio and type 2 diabetes mellitus increase the risk of major adverse cardiovascular events in patients undergoing percutaneous coronary intervention?
Effect estimate: aHR 0.83 (95% CI 0.73–0.96)
p-value: p=0.009
Elevated platelet-to-HDL-cholesterol ratio combined with type 2 diabetes mellitus is associated with a significantly higher risk of major adverse cardiovascular events at 1 year in patients undergoing percutaneous coronary intervention.
Background: The Platelet-to-HDL-cholesterol ratio (PHR), an emerging inflammatory biomarker, shows promise as a predictor in patients with type 2 diabetes mellitus (T2DM) and coronary artery disease (CAD). However, the association between PHR and glycemic metabolism status and their combined effects on the prognosis of CAD patients undergoing percutaneous coronary intervention (PCI) remains unclear. Methods: A total of 31,761 CAD patients hospitalized for PCI were included. The primary endpoint was defined as major adverse cardiovascular events (MACEs). According to the median PHR levels, patients were grouped into higher levels of PHR (PHR-H) and lower levels of PHR (PHR-L) and further divided by glycemic status into four groups: PHR-H/T2DM, PHR-H/Non-T2DM, PHR-L/T2DM, PHR-L/Non-T2DM. Results: During the 1-year follow-up, 2258 (7.1%) MACEs occurred. Elevated PHR conferred 17% excess risk for MACEs. A 1-unit increase in LnPHR was associated with a 26% increased risk of MACEs in the T2DM cohort, and a 27% increase of MACEs risks in the non-T2DM cohort. Compared to those in PHR-H/T2DM group, patients in PHR-L/T2DM, PHR-H/Non-T2DM, PHR-L/Non-T2DM had significantly decreased risk of MACEs [adjusted hazard ratio (aHR): 0.83, 95% confidence interval (CI): 0.73– 0.96, P =0.009; aHR: 0.81, 95% CI: 0.69– 0.95, P =0.009; aHR: 0.70, 95% CI: 0.60– 0.83, P < 0.001; respectively]. Cox regression analysis also indicated the highest risk of MACEs among patients in PHR-H/T2DM group than in other groups (P for trend < 0.001). Restricted cubic spline analyses revealed positive linear associations of PHR with MACEs, all-cause death, and unplanned target vessel revascularization, while a significant non-linear relationship between PHR and myocardial infarction. Additionally, subgroup analysis indicated consistent effects on MACEs within diverse subsets. Conclusion: Elevated PHR levels combined with T2DM were associated with worse clinical outcomes after PCI at 1-year follow-up. The PHR may serve as a valuable predictor for identifying high-risk patients post-PCI, particularly in diabetic cohorts.
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Yang et al. (2026) conducted a cohort in Coronary artery disease (n=31,761). Platelet-to-HDL-Cholesterol Ratio (PHR) vs. Lower PHR levels was evaluated on Major adverse cardiovascular events (MACEs) (aHR 0.83, 95% CI 0.73–0.96, p=0.009). Elevated PHR levels combined with T2DM were associated with a 16% lower risk of MACEs compared to higher PHR in diabetic patients, with an aHR of 0.83 (95% CI: 0.73–0.96).
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