GPBB and TG/HDL Ratio as Emerging Indicators in Iraqi Patients Diagnosed with Acute Coronary Syndrome

Background: ACS is one of the most critical health challenge worldwide. It consists of several conditions resulting from a sudden reduction in blood flow to the heart muscle. The early diagnosis is essential to improve the diagnostic accuracy and risk stratification. This relies on finding early, sensitive and specific biomarkers. Among these biomarkers are GPBB (glycogen phosphorylase isoenzyme BB), also referred to as the brain-type isoform (PYGB), which is primarily expressed in the brain and heart tissues and the triglyceride-to-HDL cholesterol ratio (TG/HDL). GPBB has recently gained interest as a potential early marker for myocardial ischemia with high novelty, whereas TG/HDL has been introduced as a non-conventional indicator of cardiovascular risk and atherogenic dyslipidemia. Objective of Study: 1. Evaluation of the diagnostic utility of brain-type glycogen phosphorylase (PYGB) as a potential early biomarker in patients with acute coronary syndrome (ACS). 2. Exploring the relationship between PYGB and traditional lipid profile parameters, with a particular focus on the TG/HDL ratio as a non-conventional index for cardiovascular risk prediction. 3. Improving the early detection of ischemic events and enhance risk stratification in ACS patients. Materials and Methods: The study was performed on 150 participants. They were classified into two groups: 100 patients of ACS admitted at CCU, while the other 50 individuals were healthy conducted as control group. All the risk factors that may affect on the state of patient such age, gender, smoking, diabetes mellitus, hypertension, family history, and BMI were recorded. Blood samples were collected for biochemical analysis and evaluation of study biomarkers. Results: Cardiovascular risk factors such as smoking, diabetes, hypertension, and obesity were significantly higher in ACS patients compared to controls (p < 0.05). Total cholesterol, triglycerides, and LDL levels were significantly elevated in patients, while HDL was markedly reduced (p < 0.001). The TG/HDL ratio showed a fourfold increase in patients (mean = 6.40) compared to controls (mean = 1.46, p < 0.001). PYGB levels were significantly higher in patients and demonstrated excellent diagnostic performance with an AUC of 0.98, sensitivity of 98%, and specificity of 98% at a cut-off value of 150.89 pg/mL. Furthermore, PYGB exhibited a strong negative correlation with HDL (r = –0.477, p < 0.001) and moderate positive correlations with TG (r = 0.391, p < 0.001) and TG/HDL ratio (r = 0.350, p < 0.001). Conclusion: Elevated PYGB levels reflect early myocardial ischemia, while the TG/HDL ratio represents underlying atherogenic dyslipidemia. Integrating