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. 2025 Aug;89(2):401-415.
doi: 10.1007/s12020-025-04259-y. Epub 2025 May 17.

Association of fibrinogen/albumin ratio and Castelli risk index 2 (CRI-2=LDL-C/HDL-C) with severity of coronary artery lesions in different glucose metabolism states

Yue Liu  1 , Xiandu Jin  1   2 , Wenjun Jia  1 , Xiuju Guan  3 , Hao Wu  1   2 , Jiao Li  1 , Min Cui  1   2 , Hanmo Zhang  1   2 , Liping Wei  4 , Xin Qi  5
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Association of fibrinogen/albumin ratio and Castelli risk index 2 (CRI-2=LDL-C/HDL-C) with severity of coronary artery lesions in different glucose metabolism states

Yue Liu et al. Endocrine. 2025 Aug.

Abstract

Background: The fibrinogen to albumin ratio (FAR) is a novel inflammatory indicator correlating with the severity of coronary artery disease (CAD). An indicator of atherosclerosis is the Castelli Risk Index 2 (CRI-2=LDL-C/HDL-C). Yet, little research has focused on the link between both of indicators and CAD in different glucose metabolic states. Thus, this study aimed to investigate the association between FAR, CRI-2, and the severity of coronary artery lesions in patients with CAD in different glucose metabolic states.

Method: In this investigation, coronary angiography was performed about 2825 individuals suffering from symptomatic CAD at Tianjin Union Medical Center from 2016-2023.The number of stenotic arteries in the coronary arteries was counted. The Gensini scores were taken into account. Normal glucose regulation (NGR), pre-diabetes mellitus (Pre-DM), and diabetes mellitus (DM) were the three categories of glucose status according to the WHO diabetes guidelines. Patients were also divided into FAR index and CRI-2 quartiles to look into the link between FAR index and CRI-2 and coronary artery lesions in CAD patients with different glucose metabolic states. Receiver operating characteristic (ROC) curves were constructed to analyze the predictive value of the FAR index and CRI-2 for coronary artery lesions.

Result: According to logistic regression analysis, the FAR index and CRI-2 were statistically associated with coronary artery disease (P < 0.05). The FAR index was linked with severity of coronary artery lesions regardless of glucose metabolism states (P < 0.05). The CRI-2 was strongly linked with severity of coronary artery lesions in both NGR and DM status (P < 0.05). Yet, there was no statistical significance in Pre-DM states (P > 0.05). The FAR index and CRI-2 exhibited higher regions underneath the ROC curve in forecasting severity of coronary artery lesions.

Conclusion: The FAR index and CRI-2 were significantly associated with severity of coronary artery lesions in different glucose metabolic states. FAR index and CRI-2 have predictive value for coronary artery lesions.

Keywords: Castelli risk index 2 (CRI-2=LDL-C/HDL-C); Coronary artery disease; Coronary artery disease severity; Fibrinogen/albumin ratio; Glucose metabolic state.

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Conflict of interest statement

Compliance with ethical standards. Conflict of interest: The authors declare no competing interests. Ethics approval and consent to participate: The study protocol was approved by the Ethics Committee of Tianjin Union Medical Center (IRB number:2021-C03). This study was conducted in compliance with the Declaration of Helsinki. As this was a retrospective study with no additional interventions, all patient data were anonymized to ensure confidentiality. Therefore, informed consent is not required.

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