Correlation between lipid profile and troponin I test results in patients with chest pain in Nepal

doi:10.1016/S2221-1691(13)60101-X

Asian Pacific Journal of Tropical Biomedicine

Volume 3, Issue 6, June 2013, Pages 487-491

https://doi.org/10.1016/S2221-1691(13)60101-X Get rights and content

Abstract

Objective

To study the usefulness of traditional lipid profile levels in screening subjects who had developed chest pain due to cardiac event as indicated by a positive troponin I test.

Methods

In this retrospective study data of the 430 patients presented to the emergency department with symptoms of cardiac ischemia who underwent both troponin and lipid profiles tests were compared with the lipid profiles of 165 normal healthy subjects (controls). The troponin was detected qualitatively when a specimen contains troponin I (cTnI) above the 99th percentile (TnI>0.5 ng/mL). The total cholesterol, high density lipoproteins cholesterol, very low density lipoproteins and triacyl glycerol levels were also analyzed and low density lipoprotein level was calculated using Friedewald's formula.

Results

Patients with chest pain and positive troponin test (with confirmed cardiac event) were found to have significantly elevated levels of total cholesterol, triacyl glycerol levels, low density lipoprotein level and significantly reduced high density lipoproteins cholesterol levels when compared to the patients who experienced only chest pain (negative troponin) and healthy controls.

Conclusions

Traditional lipid profile levels is still can be used in screening populations to identify the subjects with high risk of developing cardiac event in case if the laboratory set up has not troponin test facilities.

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Importantly, both studies investigated different populations (highly selected healthy individuals vs. all-comers with possible cardiovascular disease). Additionally, other researchers also demonstrated positive associations between cTn and atherogenic lipid markers (i.e. LDL-C, TC and TG) in patients with suspected or diagnosed MI [39,40]. Recent evidence from epidemiological and genetic studies indicates that elevated Lp(a) concentrations are strongly, independently and causally related to premature coronary artery disease (CAD) [41,42].
i) To assess the relationship between lipid markers and high-sensitivity C-reactive protein (hs-CRP), and high-sensitivity cardiac troponin I (hs-cTnI) in the reference population, and ii) to evaluate the impact of lipid markers and hs-CRP on the 99th percentile upper reference limit (URL) for hs-cTnI.
531 questionnaire-identified presumably healthy individuals were enrolled in a single-center, cross-sectional study. Surrogate biomarkers for diabetes, myocardial and renal dysfunction were used to refine the healthy cohort (n = 408). Lipid profile, total cholesterol:high-density lipoprotein cholesterol (HDL-C) ratio, non-HDL-C, apolipoprotein AI (apoAI), apolipoprotein B (apoB), apoB:apoAI ratio, lipoprotein(a), small dense low-density lipoprotein cholesterol (LDL-C) and hs-CRP were determined.
Individuals with detectable vs. non-detectable hs-cTnI concentrations more often showed elevated LDL-C (60% vs. 46%; p = 0.002), apoB (73% vs. 61%; p = 0.008), apoB:apoAI ratio (53% vs. 40%; p = 0.005) and lipoprotein(a) (15% vs. 7%; p = 0.015). The apoB:apoAI ratio and to a lesser extent other lipid markers, but not hs-CRP, were positively associated with hs-cTnI concentration in univariate and multivariate analyses. Exclusion of individuals with elevated apoB:apoAI ratio or apoB, but not hs-CRP, lowered the 99th percentile URL in the healthy cohort respectively by 12.9% (6.2 vs. 5.4 ng/L) and 14.5% (6.2 vs. 5.3 ng/L). The corresponding reduction for both lipid biomarkers in the presumably healthy population was 24.0% (7.5 vs. 5.7 ng/L).
Our study demonstrates that atherogenic lipid markers, particularly apoB:apoAI ratio or apoB, influence the 99th percentile URL for hs-cTnI.
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Available online 28 June 2013

Foundation project: Supported by Confederation of Epidemiological Associations registered under Govt of Kerala. Grant No. 30-955/2012 CEA.

Peer reviewer

Prof. Suryakant Nagtilak, Professor and Head, Department of Biochemistry, Subharti Institute of Medical Sciences, Meerut, Uttar Pradesh, India.

Tel: +91991917984

E-mail: [email protected]

Comments

Overall I find the paper is worth publishing as it carries a key message and it must be employed in most of the diagnostic laboratories and Intensive coronary care unit.

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Document headingCorrelation between lipid profile and troponin I test results in patients with chest pain in Nepal

Abstract

Objective

Methods

Results

Conclusions

Asian Pac J Trop Dis

Am Coll Cardiol

High-sensitivity cardiac troponin assays: what analytical and clinical issues need to be addressed before introduction into clinical practice?

Clin Chem

Assessing the requirement for the 6 hour interval between specimens in the American Heart Association Classification of myocardial Infarction in epidemiology and clinical research studies

Clin Chem

Will the real myocardial infarction please stand up?

Clin Chem

The universal definition of myocardial infarction; a consensus document: ischaemic heart disease

Heart

Document heading
Correlation between lipid profile and troponin I test results in patients with chest pain in Nepal