Looking Beyond LDL-Cholesterol - A Study on Extended Lipid Profile in Indian Patients with Acute Coronary Syndrome
Department of Cardiology, CMC Hospital, Vellore, Tamil Nadu, India.
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-naÃ¯ve 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 meanÂ±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.