Impact of baseline demographics on lipid profile in patients with ACS: Unmasking hidden drivers

Background/Synopsis

Acute coronary syndromes (ACS) remain a major global cardiovascular challenge with evolving treatment paradigms. Despite advances in management, the influence of baseline patient demographics on lipid profiles at presentation has received limited attention.

Objective/Purpose

This study explores the associations between demographic factors and lipid profile in ACS patients.

Methods

In this single-center, retrospective study, we analyzed data from 1,671 consecutive ACS patients admitted for treatment. Baseline demographics—including age, gender, comorbidities (diabetes mellitus and hypertension), and smoking status—were examined in relation to lipid profile components (total cholesterol, low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], and triglycerides) measured upon admission. Additionally, among the 853 patients who underwent coronary angiography, we evaluated the relationship between lipid levels and angiographic severity. Clinical presentations were categorized as ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), or unstable angina.

Results

The mean age of the cohort was 56.29 ± 11.73 years, with a male predominance (81.5%). Patients under 40 years exhibited significantly higher mean levels of total cholesterol, LDL-C, and triglycerides compared to those between 41 and 60 years and over 60 years (p = 0.002, 0.001, and < 0.001, respectively), potentially reflecting the more frequent use of lipid-lowering therapies in older patients. Females had higher levels of total cholesterol and HDL-C than males (p = 0.027 and < 0.001, respectively). Diabetic patients (n = 475) and hypertensive patients (n = 538) demonstrated lower LDL-C levels relative to non-diabetics and non-hypertensive individuals (p < 0.001), suggesting more aggressive lipid management and adherence to lifestyle modifications in these populations. Smokers (n = 799) presented with elevated total cholesterol and LDL-C levels compared to non-smokers (p = 0.002 and 0.02, respectively). In the subset undergoing coronary angiography, significant correlations emerged between angiographic severity and both total cholesterol and LDL-C levels (p = 0.005). Moreover, patients presenting with STEMI (68.7% of the cohort) had markedly higher total cholesterol and LDL-C levels compared to those with NSTEMI or unstable angina (p < 0.001).

Conclusions

In this South Asian cohort of ACS patients, baseline lipid profiles varied significantly with age, gender, comorbidities, smoking status, angiographic findings, and clinical presentation. These findings highlight the importance of considering demographic factors in risk stratification and tailoring lipid management strategies to improve outcomes in ACS patients.