A Prospective Study in Evaluating Clinical Utility of Novel Lipid Parameters and TyG index for Risk Stratification in Diabetes Mellitus Patients with STEMI

Abstract Background Abnormal glucose and lipid metabolism are very commonplace in individuals with myocardial infarction, while insulin resistance plays a vital role in this biological process. Nevertheless, cardiovascular risk estimation by novel lipid biomarkers based on classic lipid parameters needs assessment in myocardial infarction cohorts with diabetes mellitus (DM) according to triglyceride–glucose index (TyG) level, followed up for incident ischemic stroke events, to estimate any modification in risk estimation warrants a change in treatment. We report results from prospective cohort in such a continuing study. Methods Three novel lipid biomarkers (including proprotein convertase subtilisin/kexin type 9, Fatty acid-binding protein 4 and Resolvin D1) from different pathophysiological pathways with six traditional lipid parameters were evaluated in 1580 DM and non-DM of the myocardial infarction population cohort with 449 incident cardiovascular events (fatal or nonfatal coronary or ischemic stroke events) at median 2.02 years with follow up. Resluts 1）In the group with lower TyG levels, the risk of MACEs decreased significantly during first group (0-1 lipid parameters increased) in the DM population (HR, 0.31; 95% CI, 0.12–0.81; P=0.017) but not in patients with higher TyG levels. Similarly, among male patients, increasing number of lipid parameters index levels were associated with a stepwise higher incidence of MACEs over time (group 2, HR, 0.27; 95% CI, 0.12–0.59; P =0.001; group 3, HR, 0.42; 95% CI, 0.19–0.90; P =0.0026) in the fully adjusted Cox regression models. 2) 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. 3) 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 addition of a biomarker score including novel lipid associated biomarkers and TyG index to a conventional risk model improved risk estimation for ischemic stroke events in myocardial infarction populations with DM. Further validation is needed in other populations and age group.