Association between the gamma-glutamyl transferase to high-density-lipoprotein-cholesterol ratio and clinical outcomes in female patients with coronary heart disease

Gamma-glutamyl transferase (GGT) to high-density lipoprotein cholesterol (HDL-c) ratio (GHR), as a new combined indicator, has received attention in recent years. This study aimed to investigate the association between the GHR and coronary heart disease (CHD) in women, and to analyze its predictive value for major adverse cardiovascular events (MACE) among patients with CHD. In this retrospective longitudinal cohort study, multivariable logistic and cox regression models were used to examine associations of standardized GHR with CHD and MACE. Conventional receiver operating characteristic (ROC) analyses were used for exploratory discrimination over the overall observation period, whereas 365-day time-dependent ROC analyses were used to assess short-term discrimination while accounting for censoring. DeLong tests were used for area under curve (AUC) comparisons. A total of 3123 female patients were enrolled. Per-1-SD higher GHR was independently associated with CHD (fully adjusted OR = 2.466, 95% CI 1.943–3.130, P < 0.001), and GHR showed modest discrimination for CHD (AUC = 0.741). During a median follow-up of 665 days, 611 MACE events occurred. In the complete-case Cox model additionally adjusted for low-density lipoprotin cholesterol (LDL-c) and other clinical and laboratory covariates ( n = 683; 183 events), each 1-SD increase in GHR was associated with a higher rate of MACE (HR = 1.498, 95% CI 1.358–1.653, P < 0.001). In tertile analyses, the fully adjusted HRs were 1.902 (95% CI 1.209–2.993) for T2 and 3.291 (95% CI 2.137–5.069) for T3 versus T1 (P for trend < 0.001). Exploratory conventional ROC analysis showed the highest discrimination in patients aged ≥ 75 years (AUC = 0.737); however, the 365-day time-dependent ROC analysis showed limited discrimination overall (AUC = 0.594) and across age groups (AUC range, 0.593–0.623), with no significant between-group differences. Higher GHR was associated with CHD and incident MACE in women with CHD. However, baseline GHR alone showed limited discrimination for 1-year MACE and should not be considered a standalone short-term risk prediction marker. Prospective external validation is required before GHR can be incorporated into clinical risk assessment. Not applicable.