Background: Acute coronary syndrome (ACS) is one of the serious complications of myocardial ischemia, and notably, more than 50% of patients with ACS are elderly. In addition to pharmacological treatment and interventional procedures aimed at reducing mortality in ACS, dyslipidemia is both a pathogenic risk factor and a crucial therapeutic target to improve short- and long-term mortality rates. The morphological characteristics of dyslipidemia in elderly patients with ACS are also noted to be highly variable.
Objectives: The study aimed to investigate the characteristics of dyslipidemia in elderly patients with ACS at Nhan dan Gia Dinh hospital.
Methods: A descriptive cross-sectional study was conducted at Nhan dan Gia Dinh hospital from February 2024 to May 2024. Inclusion criteria: patients diagnosed with ACS according to the Fourth Universal Definition of Myocardial Infarction and who had fasting blood lipid tests performed within the first 24 hours of hospital admission, including total cholesterol, LDL-c, HDL-c, and triglyceride levels.
Results: Among 257 elderly patients (≥ 60 years old) diagnosed with acute coronary syndrome (ACS), the mean blood lipid profile values were: total cholesterol: 4,98 ± 2,67 mmol/L, LDL-c: 2.82 ± 1.22 mmol/L, triglycerides: 2.34 ± 1.45 mmol/L, HDL-c: 1.18 ± 0.61 mmol/L, and non-HDL-c: 3.80 ± 2.71 mmol/L. The proportion of patients presenting with dyslipidemia at admission was 75.88% (195 patients), including elevated total cholesterol in 26.85% (69 patients), elevated triglycerides in 52.92% (136 patients), elevated LDL-c in 24.51% (63 patients), combined elevation of LDL-c and triglycerides in 19.46% (50 patients), decreased HDL-c in 49.03% (126 patients), and elevated non-HDL-c in 63.04% (162 patients). There was a statistically significant difference in the proportion of patients with elevated total cholesterol and decreased HDL-c between patients with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation acute coronary syndrome (NSTEMI/UA), with p-values of 0.024 and 0.025 respectively. Additionally, subgroup analysis showed that elderly male patients (≥ 60 years old) with elevated total cholesterol or combined elevation of LDL-c and triglycerides had an increased risk of STEMI by 1.94 times (95% CI: 1.32-2.86, p < 0.05) and 1.66 times (95% CI: 1.10 - 2.50, p < 0.05), respectively; a history of smoking together with elevated total cholesterol and combined elevation of LDL-c and triglycerides was associated with a higher risk of STEMI by 1.76 times (95% CI: 1.06 - 2.95, p < 0.05) and 1.98 times (95% CI: 1.21 - 3.25, p < 0.05), respectively; hypertensive patients with elevated LDL-c had a higher likelihood of developing STEMI by 1.56 times (95% CI: 1.02 - 2.40, p < 0.05).
Conclusions: More than three-quarters of elderly ACS patients (≥ 60 years old) at hospital admission had dyslipidemia, with the most common patterns being elevated non-HDL-c, elevated triglycerides, and decreased HDL-c. Clinical risk factors and lipid profile patterns in elderly patients differed significantly between STEMI and NSTEMI/UA groups.