Exploring the Intersections between Triglyceride-rich Lipoproteins and Acute Coronary Syndrome: A Cross-sectional Study.

Background: Within 20 years, cardiovascular disease (CVD), which is currently the main cause of death in the Indian subcontinent, is expected to overtake all other causes of death in South Asia. Acute coronary syndrome (ACS), a critical form of CVD, is associated with multiple risk factors including hyperlipidemia. While triglyceride-rich lipoproteins (TRLs) and their remnants are well-studied traditional markers such as low-density lipoprotein (LDL-C) and high-density lipoprotein-cholesterol (HDL-C), new research indicates that they may possibly be important in ACS risk. Delayed removal of CM and very LDL remnants has been linked to increased cardiovascular risk. This study aims to explore the association between TRL-C, a surrogate marker for these atherogenic lipoproteins, and ACS.

Materials and methods: Between November 2018 and March 2020, a cross-sectional study was carried out in hospitals at Smt. Sucheta Kriplani Hospital and Lady Hardinge Medical College in New Delhi. The study included 200 patients aged 18 or older, diagnosed with ACS. Data were collected on lipid profiles and cardiac biomarkers from venous blood samples. TRL-C was computed by subtracting LDL-C and HDL-C from total cholesterol. Patients were divided into three groups according to the type of ACS they had ST elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI), and unstable angina (UA). Statistical analyses, including ANOVA and Kruskal-Wallis tests, were used to examine associations between TRL-C levels and ACS types.

Results: The average TRL-C was significantly higher in STEMI patients (43.68 mg/dL) compared to NSTEMI (31.27 mg/dL) and UA (25.31 mg/dL) (P < 0.0001). The study found no significant associations between TRL-C levels and the use of statins or between previous ACS events and the spectrum of current ACS.

Conclusion: TRL-C is significantly associated with the severity of ACS, with higher levels correlating with more severe forms of the condition. Despite the use of statins, TRL-C levels remained a significant predictor of ACS severity, suggesting that TRL-C could be a valuable marker for assessing cardiovascular risk beyond traditional lipid profiles. Further research is needed to explore the role of TRL-C in recurrent ACS and its potential utility in refining treatment strategies.