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Background The correlation among the ratios of low-density lipoprotein cholesterol/high-density lipoprotein cholesterol (LDL-C/HDL-C), total cholesterol/high-density lipoprotein cholesterol (TC/HDL-C) and thin-cap fibroatheroma has not yet been established.Methods It was a single center, retrospective observational study. In total, we recruited 421 patients (82.4％ men; mean age 65.73 ± 10.44 years) with one culprit vessel which determined by intravascular optical coherence tomography (OCT). The thinnest-capped fibroatheroma(TCFA) group was defined as lipid contents in ＞ 2 quadrants, with the thinnest fibrous cap measuring less than 65 μm. Univariate and multi?variate logistic regression were carried out to explore the relationship between lipoprotein ratios, TCFA and other characteristics of plaque.To compare different ratios, the area under curve (AUC) of receiver-operating characteristic (ROC) curve was assessed. Results OCT was performed in 421 patients (TCFA group (n = 109), non-TCFA group (n = 312)). LDL-C/HDL-C in the TCFA group was significantly higher than in the non-TCFA group (2.95 ± 1.20 vs. 2.43 ± 0.92, P ＜ 0.05), as was TC/LDL in TCFA and non-TCFA group (4.57 ± 1.58 vs. 4.04 ±1.13, P ＜ 0.05). Both LDL-C/HDL-C (OR: 1.002 (1.002-1.003), P ＜ 0.05) and TC/HDL-C (OR: 1.001 (1.001-1.004), P ＜ 0.05) were con?sidered independent factors for the prediction of TCFA according to the logistic regression. Based on the AUC comparison, LDL-C/ HDL-C and TC/HDL-C had no significant difference statistically (LDL-C/HDL-C AUC: 0.63; TC/HDL-C AUC: 0.61; P = 0.10) for the prediction of TCFA. Conclusions LDL-C/HDL-C and TC/HDL-C could be the independent factors for predicting the presence of TCFA, indicating coronary plaque vulnerability in CAD patients. Moreover, TC/HDL-C also showed a comparative performance for the prediction of TCFA as LDL-C/HDL-C.