Utility of Novel Lipid Parameters for Risk Stratification in Patients with Diabetes and STEMI–from a Prospective Study

Xiaoxiao Zhao,1 Runzhen Chen,1 Jiannan Li,1 Jinying Zhou,1 Nan Li,1 Linghan Xue,1 Shaodi Yan,2 Chen Liu,1 Peng Zhou,1 Yi Chen,1 Li Song,1 Hanjun Zhao,1 Hongbing Yan1,3 1Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, People’s Republic of China; 2Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, People’s Republic of China; 3Beijing Amcare Hospital, Beijing, People’s Republic of ChinaCorrespondence: Hongbing Yan, Department of Cardiology, Beijing Amcare Hospital, Beijing, People’s Republic of China, Tel +86-13701339287, Email hbyanfuwai2018@163.com Hanjun Zhao, Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China, Tel +86-15210020808, Email 15210020808@163.comIntroduction: Abnormalities in glucose and lipid metabolism are prevalent among individuals suffering from myocardial infarction, with insulin resistance playing an integral role in these pathological processes. This study aims to follow up on incident ischemic stroke events to evaluate whether any alterations in risk estimation merit a reassessment of therapeutic strategies. Herein, we present findings derived from a prospective cohort engaged in this ongoing investigation.Material and Methods: In our analysis, three novel lipid biomarkers—namely proprotein convertase subtilisin/kexin type 9, fatty acid-binding protein 4, and Resolvin D1—emanating from diverse pathophysiological pathways were meticulously evaluated alongside six conventional lipid parameters within a population cohort comprising 1580 individuals, both diabetic and non-diabetic.Results: 1) Furthermore, among DM patients, group 1 (0– 1 lipid parameters increased) and group 2 (2– 4 lipid parameters increased) had significantly better ischemic stroke-free survival than other groups (p=0.025) when TyG index ≥median. 2) Adding novel lipid associated parameters and TyG index to the conventional lipid risk factors model in the cohort validated it by improved net reclassification index (p< 0.05) and integrated discrimination improvement and led to significant reclassification of individuals into risk categories.Conclusion: The incorporation of a biomarker score that encompasses innovative lipid-associated biomarkers alongside the TyG index into a traditional risk assessment framework significantly enhanced the evaluation of ischemic stroke events within myocardial infarction populations afflicted by diabetes mellitus.