Cholesterol, high-density lipoprotein, and glucose index as a cardiometabolic marker associated with heart rate variability and 1-year cardiovascular rehospitalization in chronic coronary syndromes with comorbid anxiety: a retrospective cohort study.

BACKGROUND

Metabolic dysregulation and autonomic imbalance may be related to adverse outcomes in patients with chronic coronary syndromes (CCS) and comorbid anxiety. We investigated the associations of the cholesterol, high-density lipoprotein, and glucose (CHG) index with a composite heart rate variability measure (HRV_z) and 1-year cardiovascular rehospitalization in this high-risk population.

METHODS

This single-center retrospective cohort study included 1020 hospitalized patients with CCS and comorbid anxiety between January 2022 and January 2025. Among them, 571 patients with available 24-h Holter recordings were included in exploratory HRV-related analyses. Demographic, laboratory, Holter-derived HRV, and 1-year cardiovascular rehospitalization data were collected. Missing data were handled using multiple imputation. Multivariable linear and logistic regression models, together with restricted cubic splines, were used to examine linear and nonlinear associations.

RESULTS

Compared with patients in the lowest CHG quartile (Q1), those in the highest quartile (Q4) had significantly lower HRV_z in the Holter subgroup (β = -0.529, 95% CI -0.698 to -0.361; P < 0.001). In the overall cohort, each 1-unit increase in CHG was associated with a higher risk of 1-year cardiovascular rehospitalization (OR = 3.253, 95% CI 2.292-4.617; P < 0.001), and patients in Q4 had a higher risk than those in Q1 (OR = 3.656, 95% CI 2.443-5.472; P < 0.001). In exploratory Holter subgroup analyses, higher HRV_z was associated with lower rehospitalization risk. Restricted cubic spline analyses suggested nonlinear associations among CHG, HRV_z, and rehospitalization risk. Complete-case sensitivity analyses generally supported the main findings, although HRV-related results should be interpreted cautiously.

CONCLUSIONS

In patients with CCS and comorbid anxiety, elevated CHG was associated with increased 1-year cardiovascular rehospitalization risk. Exploratory Holter subgroup analyses suggested that higher CHG was associated with lower HRV_z, and lower HRV_z with higher rehospitalization risk. CHG, together with Holter-derived HRV_z, may provide complementary information for risk assessment in this population.