Key result
Specific metabolic risk factors, including high waist-hip ratio (OR 2.4), high HbA1c (OR 3.2), and low HDL-C (OR 2.2), were significantly associated with first acute coronary syndrome.
Why the study?
In acute coronary syndrome patients, focus is often on major conventional risk factors, whereas specific metabolic risk factors receive less attention.
Are specific metabolic risk factors associated with the first incidence of acute coronary syndrome in Indian patients?
Case-Control (n=3,363)
Yes
Are specific metabolic risk factors associated with the first incidence of acute coronary syndrome in Indian patients?
In the Indian population, specific metabolic risk factors including high waist-hip ratio, low HDL-C, and high HbA1c confer a risk for first acute coronary syndrome comparable to conventional risk factors.
May support metabolic screening in Indian primary prevention; leaves open whether modification reduces first ACS.
OBJECTIVES: In acute coronary syndrome (ACS) patients the focus is on major conventional risk factors - CRF [diabetes, hypertension, elevated low-density cholesterol (LDL-C) and smoking] whereas others - specific metabolic risk factors - MRF [high-density lipoprotein cholesterol (HDL-C), body-mass index (BMI), waist-hip ratio (WHR), and triglycerides, and HbA1c get less attention. METHODS: This is a prospective case-control observational study from 15 tertiary care hospitals in India. CRF and MRF in patients presenting with first incidence of ACS (n = 2153) were compared with matched controls (n = 1210). RESULTS: Propensity score matching (PSM) yielded 1193 cases and matched 1210 controls. Risk factor prevalence in cases vs. controls were CRF: hypertension - 39.4% vs 16.4% (p < 0.0001), diabetes - 42.6% vs 12.7% (p < 0.0001), smoking - 28.3% vs 9.3% (p < 0.0001) and elevated LDL-C - 70.2% vs 57.9% (p < 0.0001). MRF: High BMI - 54.7% vs 55.1% (p = 0.84), increased waist: hip ratio 79.5% vs 63.6% (p < 0.0001), high HbA1c - 37.8% vs 14.9% (p < 0.0001), low HDL-C - 56.2% vs 42.8% (p < 0.0001) and elevated triglycerides - 49.7% vs 44.2% (p = 0.007). Adjusted Odds ratios by multivariate analysis were CRF: hypertension - 2.3 (p < 0.001), diabetes - 4.7 (p < 0.001), high LDL-C - 3.3 (p < 0.001) and smoking- 6.3 (p < 0.001). MRF: High waist: hip ratio - 2.4 (p < 0.001) high HbA1c - 3.2 (p < 0.001), low HDL-C 2.2 (p < 0.001) and elevated triglycerides - 0.878 p = 0.17. CONCLUSION: In India, the risk of ACS conferred by specific metabolic risk factors (High waist: hip ratio, Low HDL-C and High HbA1c) is comparable to that caused by CRF.
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Rao et al. (2022) conducted a case-control in Acute coronary syndrome (n=3,363). Specific metabolic risk factors (high waist-hip ratio, high HbA1c, low HDL-C) vs. Absence of risk factors was evaluated on First incidence of acute coronary syndrome (OR 2.4, p=<0.001). Specific metabolic risk factors, including high waist-hip ratio (OR 2.4), high HbA1c (OR 3.2), and low HDL-C (OR 2.2), were significantly associated with first acute coronary syndrome.
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