Metabolic, Atherogenic, and Anthropometric Markers for Discrimination of Premature Coronary Artery Disease in a Predominantly Statin-Treated Cohort

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.