Comparison of Atherogenic Coefficient and Castelli Risk Indices in Diabetic and Non-Diabetic Patients Presenting with Acute Coronary Syndrome

Abstract

Objectives: Lipid-derived indices such as the Atherogenic Coefficient (AC) and Castelli Risk Indices (CRI-I and CRI-II) provide composite measures of atherogenic and protective lipoproteins and may offer improved risk stratification. Aim of this study was to compare AC, CRI-I, and CRI-II between diabetic and non-diabetic patients presenting with ACS and to evaluate their association with demographic and clinical characteristics. Methodology: This cross-sectional study enrolled 103 patients admitted with ACS at a tertiary care center. Demographic data, clinical characteristics, and fasting lipid profiles were collected. AC, CRI-I, and CRI-II were calculated using standard formulas. Group comparisons were performed using appropriate parametric and non-parametric tests. Multivariable linear regression was used to identify independent predictors of atherogenic indices. Results: The mean age of participants was 59.4 ± 12.7 years, with 47.6% having diabetes mellitus. AC and CRI-I did not differ significantly between diabetic and non-diabetic participants, whereas CRI-II was significantly higher among non-diabetics (p = 0.024). Smoking was consistently associated with higher AC, CRI-I, and CRI-II and emerged as the strongest independent predictor across all multivariable models (p < 0.05). Other traditional cardiovascular risk factors, including age, sex, diabetes mellitus, hypertension, anemia, and physical activity, were not independently associated with atherogenic indices after adjustment. Conclusion: Among patients presenting with ACS, smoking is the most consistent determinant of elevated atherogenic indices, whereas diabetes mellitus and other traditional risk factors do not independently predict these indices after multivariable adjustment. Lipid-derived indices, particularly CRI-II, may provide complementary information for residual cardiovascular risk assessment in high-risk ACS populations, especially in resource-limited settings.