Evaluation of Advanced Lipid Biomarkers and Novel Atherogenic Indices in Predicting Coronary Artery Disease Severity Among Very Premature ACS Patients

Introduction Premature coronary artery disease occurs in men under 55 and women under 65 years, with very premature cases appearing as early as 45. It can affect patients with normal lipid levels, and the absence of specific guidelines for the Indian population leads to inadequate detection and management of coronary artery disease. This underscores the need for advanced lipid indices to identify the subset of patients at risk of very premature coronary artery disease more effectively. Aim The objective is to assess the significance of advanced lipid profile in very premature coronary disease patients. Materials and Methods The study was conducted between September 2022 and August 2024. 136 patients were evaluated, and 100 patients satisfied the eligibility criteria. The estimation of conventional lipid parameters (triglycerides, high-density lipoprotein, low-density lipoprotein, and total cholesterol) and advanced lipid parameters-apolipoprotein A1, lipoprotein (a), and apolipoprotein B-100 was done in each patient. Novel lipid indices, such as the lipid pentad index, lipid tetrad index, and atherogenic index of plasma, were calculated from the conventional lipid parameters. Modified Gensini score was used for the severity of coronary artery disease. Results The main age group among patients was 35-45 years. ST-segment elevation myocardial infarction was seen in 63% of cases, with diabetes as the most common risk factor (31%), followed by hypertension (28%) and smoking/alcohol use 22% Coronary angiography showed total occlusion in 20% of patients (17% ST-segment elevation myocardial infarction, 3% non-ST-segment elevation myocardial infarction) and subtotal occlusion in 26% (24% ST-segment elevation myocardial infarction, 2% non-ST-segment elevation myocardial infarction). The correlation between the modified Gensini score and the new indices—lipid pentad index (0.67), lipid tetrad index (0.57), and atherogenic index of plasma (0.67)—was statistically significant ( P < .0001). Conclusion An advanced lipid profile, compared with a conventional lipid profile, is more effective in screening young Indian individuals for coronary artery disease.