Looking Beyond LDL-Cholesterol - A Study on Extended Lipid Profile in Indian Patients with Acute Coronary Syndrome
Published: November 1, 2019 | DOI: https://doi.org/10.7860/JCDR/2019/42638.13260
Naveen Kumar, Lijo Varghese, Sujith Thomas Chacko, Rekha Karuppusami, Arun Jose, George Joseph
1. Assistant Professor, Department of Cardiology, Christian Medical College, Vellore, Tamil Nadu, India.
2. Associate Professor, Department of Cardiology, Christian Medical College, Vellore, Tamil Nadu, India.
3. Associate Professor, Department of Cardiology, Christian Medical College, Vellore, Tamil Nadu, India.
4. Lecturer, Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India.
5. Lecturer, Department of Clinical Biochemistry, Christian Medical College, Vellore, Tamil Nadu, India.
6 Professor, Department of Cardiology, Christian Medical College, Vellore, Tamil Nadu, India.
Correspondence
Lijo Varghese,
Department of Cardiology, CMC Hospital, Vellore, Tamil Nadu, India.
E-mail: lijo97@gmail.com
Introduction: Assessment of dyslipidemia with only Total Cholesterol (TC), Triglyceride (TGL), Low- and High-Density Lipoprotein Cholesterol (LDL-C, HDL-C) levels, Standard Lipid Profile (SLP), leads to under-estimation of dyslipidemia as a risk factor in Acute Coronary Syndrome (ACS).
Aim: To assess whether extended lipid profile gives a better risk assessment in ACS patients.
Materials and Methods: In this single-centre, prospective, observational study of statin-naïve patients presenting with ACS, SLP and Extended Lipid Profile (ELP), consisting of TC/HDL-C ratio, non-HDL-C, apolipoprotein-B, apolipoprotein-A1 and their ratio, were studied at baseline and after high-intensity statin therapy. For continuous data, descriptive statistics mean±standard deviation and also 25th-75th percentile was reported. Number of patients and percentages were reported for categorical data. Pearson correlation coefficient was used to find the relationship between continuous variables.
Results: In the present study, 139 patients (mean age 55 years, range 21-88 years, 78% male) presented with ACS: ST-Elevation Myocardial Infarction (STEMI) 79%, non-STEMI 17%, Unstable Angina (UA) 4%. The ELP (barring non-HDL-C) showed more dyslipidemia than SLP. Dyslipidemia declined across the age spectrum from young to old and worsened across the ACS spectrum from UA to STEMI. High-intensity statin therapy reduced LDL-C significantly but not to target levels in most patients.
Conclusion: ELP is better able to identify dyslipidemic risk than SLP or LDL-C alone. Dyslipidemia is more prevalent in young and STEMI patients, suggesting a greater role as risk factor in them. Achievement of target LDL-C with statin therapy remains practically elusive in most patients.
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