Role of risk assessment using lipid ratios and adiposity markers in young patients with a first acute coronary syndrome

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background/Introduction Low-density lipoprotein cholesterol (LDL-C) remains the gold standard for lipid assessment in atherosclerotic cardiovascular disease (ASCVD). Recent guidelines remark the importance of non-high-density lipoprotein cholesterol (non-HDL-C) and apolipoprotein B (ApoB) in lipid risk assessment. Moreover, lipid ratios (LR) add information about small, dense LDL-C and other atherogenic lipoproteins. The presence of adiposity confers a higher metabolic and lipidic risk. Purpose To describe ApoB, non-HDL-C, remnant cholesterol (RC) and lipid ratios (LR) in young patients admitted for a first acute coronary syndrome (ACS); and to correlate those values with body mass index (BMI) and glycated haemoglobin (HbA1c) as adiposity and metabolic syndrome markers. Methods We performed a descriptive and retrospective study including 51 patients under 65 years old, admitted to hospital between July 2022 and October 2022, for an ACS irrespective of the onset (unstable angina, non-ST-segment or ST-segment elevation myocardial infarction (NSTEMI, STEMI)). We assessed a basic lipid profile including, HbA1c, total cholesterol (TC), LDL-C, HDL-C, triglycerides (TG) and ApoB. Non-HDL-C, RC and the following LR (TC/HDL-C, TG/HDL-C, LDL-C/HDL-C, non-HDL-C/HDL-C, LDL-C/ApoB, TC/ApoB and TG/ApoB) were estimated. Results In our study. 76,5% were male. Mean age was 56,1 years (± 7,3). The percentage of history of risk factors was: smoking 68,6%, hypertension 52,9%, diabetes 31,4%, dyslipidaemia 43,1%. 30 patients had STEMI (58,8%), 17 NSTEMI (33,3%). Mean BMI and HbA1c were 29,46 kg/m2 (±5,9) and 6,1% (±1,07), respectively. Mean waist circumference was 98 cm (±13,95) Mean values of the lipid profile were: LDL-C 89,74 mg/dL (±35,58), HDL-C 33,8 mg/dL (±8,4), TG 161,14 mg/dL (±66,26), non-HDL-C 122,28 mg/dL (±38,96), RC 32,54 mg/dL (±14,86), ApoB 97,6 mg/dL (±26,88). Mean LR were: TG/HDL-C 5,04 (±2,33), LDLc/ApoB 0,92 (±0.2). The rest of the characteristics and results are shown in Table 1. We found statistically significant positive correlation between: TG and ApoB (r: 0,345; P=0,014); TG and TC/HDL-C ratio (r:0,326; P=0,21); TG and HbA1c (r: 0,349; P=0,02); TG an RC (r: 0,978; P<0,001); HbA1c and TG/ApoB ratio (r: 0,392; P<0,01); BMI and HbA1c (r: 0,572; P=0,013); TG/HDL-C and BMI (r: 0,493; P=0,032). Conclusions Lipid ratio assessment plays a key role in patients with adiposity, remarkably high in our serie. In our cohort, these patients had TG/HDL-C ratio > 2 and LDL-C/ApoB ratio < 1.3, meaning small and dense circulating lipoproteins. Our results support the implementation of LR in clinical practice as they may guide the intensification of lipid lowering therapies beyond LDL-C.