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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 5  |  Issue : 2  |  Page : 184-190

Atherogenic index of plasma: A novel biomarker and lipid indices in young myocardial infarction patients


1 Department of Biochemistry, G.B Pant Institute of Postgraduate Medical Education and Research, Associated Maulana Azad Medical College, GNCTD, New Delhi, India
2 Department of Biochemistry, Chacha Nehru Bal Chikitsalya, Associated to Maulana Azad Medical College, New Delhi, India
3 Department of Cardiology, G.B Pant Institute of Postgraduate Medical Education and Research, Associated Maulana Azad Medical College, GNCTD, New Delhi, India

Date of Submission14-Apr-2021
Date of Acceptance24-Apr-2021
Date of Web Publication16-Jun-2021

Correspondence Address:
Mohit Dayal Gupta
Department of Cardiology, G.B Pant Institute of Postgraduate Medical Education and Research, Associated Maulana Azad Medical College, GNCTD, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/bbrj.bbrj_58_21

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  Abstract 


Background: Cardiovascular diseases (CVDs) have become the leading cause of death among Indian population. It has been directly linked to hypercholesterolemia, particularly elevated plasma low-density lipoprotein-cholesterol (LDL-C) levels and low plasma high-density lipoprotein-cholesterol (HDL-C) levels. The lipid tetrad index (LTI) and lipid pentad index (LPI) have been recently described as a new form of assessment of lipid profiles. Hence, the present study was undertaken to evaluate the role of atherogenic index of plasma (AIP) and other lipid indices such as LTI and LPI in young myocardial infarction (MI) patients from North India.Methods: The present cross-sectional study was conducted in the Department of Biochemistry and Cardiology at GB Pant Institute of Postgraduate Medical Education and Research, New Delhi. A total of 240 individuals were included in the study in which 135 were patients of ST-elevation MI of the age 15–45 years, along with 105 age-matched controls during the period of July 2019 till December 2019. LTI was calculated as TC*TG*Lp(a)/HDL and LPI as TC*TG*Lp(a)*ApoB/ApoA1. AIP is calculated according to the formula: log (TG/HDL-C). Results: The lipid parameters including total cholesterol, triglyceride, LDL-C, and non-HDL-C were significantly increased in the acute MI cases in comparison to controls. HDL-C was significantly decreased in the cases. Lipoprotein (a), ApoB levels, and ApoB/ApoA1 were also significantly increased in the cases. On the other hand, ApoA1 levels were significantly decreased in the patients. LTI and LPI were significantly increased in the acute MI cases as compared to controls. On correlating lipid parameters with LTI and LPI, a significant positive correlation was observed with all lipid parameters – total cholesterol, triglyceride, LDL-C, Lp(a), and ApoB/ApoA1 except HDL-C which showed a negative correlation with LTI and a nonsignificantly negative correlation with LPI. HDL-C shows a significantly negative correlation with AIP in both cases and controls. Conclusions: This present study has evaluated Role of AIP along with lipid indices such as LTI & LPI which helps in early identification of individuals with higher risk of premature CAD. AIP can be used as a better biomarker than other lipid indices in young MI patients, especially those associated with cardiovascular risk. At present, no Lp(a)-lowering drugs have been approved, hence early identification and intervention to modify risk factor may be helpful in prevention of development of MI in these patients with the help of LTI and LPI levels.

Keywords: Atherogenic index of plasma, cardiovascular disease, lipid pentad index, lipid tetrad index, myocardial infarction, young myocardial infarction


How to cite this article:
Dabla PK, Sharma S, Saurabh K, Chauhan I, Girish M P, Gupta MD. Atherogenic index of plasma: A novel biomarker and lipid indices in young myocardial infarction patients. Biomed Biotechnol Res J 2021;5:184-90

How to cite this URL:
Dabla PK, Sharma S, Saurabh K, Chauhan I, Girish M P, Gupta MD. Atherogenic index of plasma: A novel biomarker and lipid indices in young myocardial infarction patients. Biomed Biotechnol Res J [serial online] 2021 [cited 2021 Jul 23];5:184-90. Available from: https://www.bmbtrj.org/text.asp?2021/5/2/184/318434




  Introduction Top


At the turn of the century, cardiovascular diseases (CVDs) have become the leading cause of mortality in India.[1] In comparison to the European population, CVD affects Indian population a decade earlier. In the West, only 23% of CVD deaths occur below 70 years of age whereas this number is nearly double when compared to the Indian population.[2] This high prevalence of CVD is due to genetic factors, as well as environmental events that can lead to the onset and progression of atheromatous plaques. Acute myocardial infarction (MI) is an important form of CVD. Approximately 1.5 million individuals suffer from acute MI annually and almost one-third of them die.[3],[4] Unbalanced diet, smoking, physical inactivity, diabetes, and high cholesterol are factors that enhance the risk of developing CVD.[3]

Nonconventional factors such as hyperinsulinemia, insulin resistance, and lipoprotein (a) (Lp[a]) are determined by genes, and their high prevalence among Indians probably explains the precocious nature of CVD that typically affects Indians.[5] Coronary artery disease (CAD) has been directly linked to hypercholesterolemia, particularly elevated plasma levels of low-density lipoprotein-cholesterol (LDL-C) and low plasma levels of high-density lipoprotein-cholesterol (HDL-C).[6] The role of triglycerides as an independent risk factor for CVD has also been debated for a long time. High triglyceride levels are a significant independent predictor of coronary heart disease and ischemic stroke.[7]

The lipid tetrad index (LTI) and pentad index (LPI) have been recently described as a new form of assessment of lipid profiles.[8] Based on the conventional lipid profile and the emerging risk factors such as Lp(a), apolipoprotein A-I (ApoA-I), and ApoB, LTI and LPI appear as models in global risk assessment, considering the multifactorial nature of CVD.[9] It is essential to therefore look into the combinations of these lipid parameters to measure the total burden of dyslipidemia as it eliminates the need for various cutoff points for each individual parameter.

Atherogenic index of plasma (AIP) is a novel index composed of triglycerides and HDL-C. It has been shown to be a good marker of atherogenicity and implicated with worse clinical outcomes in the general population as well as those with high cardiovascular risk. Altered atherogenic and protective lipoproteins ratio have greater chances of cardiovascular risk identification as compared to conventional lipid components. Among those ratios, AIP has been reported to be a better biomarker for CAD and type 2 diabetes than the conventional lipids.[10]

Hence, the present study was undertaken to evaluate the role of AIP and other lipid indices such as LTI and LPI in young MI patients from North India.


  Materials and Methods Top


The present cross-sectional study was conducted in the Department of Biochemistry and Cardiology at GB Pant Institute of Postgraduate Medical Education and Research, New Delhi. A total of 240 individuals were included in the study in which 135 were patients of ST-elevation MI of the age 15–45 years, along with 105 age-matched controls. Patients with stable or unstable angina and those having age <15 or above 45 years were excluded from the study. A detailed patient history and physical examination along electrocardiogram (ECG) and biochemical evaluation were done with a predesigned format.

The final diagnosis of acute MI (AMI) was based on the following criteria:

  1. Ischemic chest pain lasting 20 min or more
  2. ECG evidence of myocardial injury: (a) ≥0.1 mv ST elevation in two contiguous leads other than V2–V3 where the cutoff point of ≥0.2 mv in men ≥40 years, ≥0.25 mv in men <40 years, or ≥0.15 mv in women. (b) New horizontal or downsloping ST depression ≥0.05 mv in two contiguous leads and/or T-wave inversion ≥0.1 mv in two contiguous leads with prominent R-wave or R/S ratio >1
  3. Positive biomarkers: creatine kinase-MB fraction and cardiac troponins.


Both weight and height were measured in light clothes and without shoes using the standard apparatus. The weight was measured using calibrated electronic weighing scales before eating in the morning, and the height was measured to the nearest centimeter using a portable stadiometer. Body mass index (BMI) of the participants was calculated using standard formula: BMI = weight (kg)/(height (m2). 6–8 mL of venous blood samples was taken under aseptic precautions, after obtaining written informed consent from the participants. Biochemical markers measured were lipid profile including total cholesterol, triglyceride, LDL-C, HDL-C, ApoA1, ApoB, and Lp(a). Lipid profile was determined by calorimetric method using kits provided by Roche, Switzerland. ApoA1, ApoB, and Lp(a) were determined by the immunoturbidimetric method using kits supplied by Roche, Switzerland. LTI was calculated as TC*TG*Lp(a)/HDL and LPI as TC*TG*Lp(a)*ApoB/ApoA1. AIP is calculated according to the formula: log (TG/HDL-C). The study was approved by the local institutional ethical review board.

Statistical analysis

All the data were presented as mean ± standard deviation. The Statistical Package for the Social Sciences version 20 (IBM, SPSS Statistics 20, Armonk, NY, USA) was used for data analysis. Student's unpaired t-test was used for intergroup comparisons of normally distributed parameters. Pearson's correlation was used to find the possible relationship between studied parameters. P < 0.05 was considered to be statistically significant.


  Results Top


[Table 1] shows the sociodemographic variables of the participants. There were 135 cases of acute MI with a mean age of 36 ± 4.5 years. Majority (84%) of the participants were in the age group of 31–45 years. The average BMI was 25.7 ± 4.31 kg/m2, with 15.5% of the patients having BMI >30 kg/m2. The mean systolic and diastolic blood pressure was 118.4 ± 15.5/75.6 ± 9.61 mmHg, respectively. 9.63% of the patients under study were diabetic, 8.8% were hypertensive, and 8.9% had a history of dyslipidemia. 70.4% of the patients were active smokers, 66.7% had a history of tobacco consumption, and 30.4% were alcoholics. Most of the patients had a sedentary lifestyle (93.3%) and only 13.3% were on medication with statins. Majority of the patients presented to the emergency department with symptoms of chest pain and sweating (96.2% and 81.4%, respectively), with anterior wall MI being the most common ECG finding (60.7%).
Table 1: Demographic variables of the acute myocardial infarction cases under study

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The lipid parameters including total cholesterol, triglyceride, LDL-C, and non-HDL-C were significantly increased in the acute MI cases in comparison to controls as shown in [Figure 1]. HDL-C was significantly decreased in the cases. Lipoprotein(a), ApoB levels, and ApoB/ApoA1 were also significantly increased in the cases. On the other hand, ApoA1 levels were significantly decreased in the patients. LTI and LPI were significantly increased in the acute MI cases as compared to controls (46433.98 ± 70314.4 vs. 12940.7 ± 7768.2, P < 0.0001, and 1459906.59 ± 2298888.1 vs. 412972.93 ± 70667.2, P < 0.0001), respectively, as shown in [Table 2] and [Table 3] and in [Figure 2] and [Figure 3].
Figure 1: Lipid profile in cases and controls

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Table 2: Comparison of conventional lipid profile in study and control groups

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Table 3: Comparison of lipid indices in study and control groups

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Figure 2: ApoA1, ApoB, and ApoB/ApoA1 in cases and controls

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Figure 3: Lipid tetrad index in cases and controls

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[Table 4] shows the evaluation of the risk factors in the study group. Among the conventional lipid parameters, 68.9% of the patients had high Lp(a) levels and 48.8% had low levels of HDL-C. Forty percent of the patients had high triglyceride levels, 25.1% had a high ApoB/ApoA1 ratio, 13.3% were with high total cholesterol, and 12.5% with high LDL levels. When evaluating the lipid indices, 56.2% of the patients had high LTI levels.
Table 4: Risk factors in study group

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On correlating lipid parameters with LTI, a significant positive correlation was observed with all lipid parameters – total cholesterol, triglyceride, LDL-C, Lp(a), and ApoB/ApoA1 (P < 0.0001, P < 0.0001, P < 0.001, P < 0.0001, and P < 0.0001, respectively) except HDL-C which showed a significantly negative correlation (P < 0.01) with LTI. Whereas on correlating with LPI, a significant positive correlation was observed with total cholesterol, triglyceride, LDL-C, Lp(a), and ApoB/ApoA1 (P < 0.0001, P < 0.0001, P < 0.0001, P < 0.0001, and P < 0.0001, respectively). HDL-C also showed a negative correlation with LPI but was not significant statistically (P > 0.05).

HDL-C shows a significantly negative correlation with AIP in both cases and controls.


  Discussion Top


CVD incidence is increasing nowadays in almost all age groups, but many studies had now reported increased cases in young population,[11],[12] resulting in sudden death with acute presentation.[13] The National Inpatient Sample data showed a higher prevalence of risk factors, ischemic stroke, and increased rate of hospital admission in young MI patients.[14],[15] There is a lack of data on young MI patients. The Framingham Heart Study has defined young MI patients with age <45 years.[16]

The average BMI was 25.7 ± 4.31 kg/m2, with 15.5% of the patients having BMI >30 kg/m2 in our study. As similar to our study, previous studies had also reported higher BMI among young MI patients as compared to healthy controls.[17],[18] The incidence of obesity is increasing in young population at a very fast pace which increases the future risk of MI among this population.[19],[20]

The present study reported 9.63% of patients as diabetic, 8.8% as hypertensive, and 8.9% had a history of dyslipidemia. Mcmanus et al. and Chan et al. also reported a 14.7% and 38.1% prevalence of diabetes and hypertension in young MI patients.[19],[21] Hypertension remains underdiagnosed in young patients, which left untreated for long time resulting in higher risk of MI in young population.[22] Although diabetes is less common among young individuals, it is also considered as a risk factor for MI at younger age. Compared to nondiabetic young individuals, the adjusted OR of MI among men <45 years of age with diabetes has been shown to be 8.34 (95% CI, 1.67–41.6).[23] The risk for CAD increases 3-fold in the absence of other risk factors, 8-fold with low HDL, 12-fold with high LDL, 16-fold with diabetes, and 25-fold with high TC/HDL ratio when associated with increase in plasma Lp(a) levels.[24]

The lipid parameters including total cholesterol, triglyceride, LDL-C, and non-HDL-C were significantly increased in the acute MI cases in comparison to controls. HDL-C was significantly decreased in the cases. Similar results of lipid parameters were also reported by Senthilkumari et al.[25] Triglyceride levels almost double the risk for CAD occurrence with increase in levels from 90 mg/dL to 180 mg/dL. Hypertriglyceridemia has been observed to be an important factor underlying the pathogenesis of CAD because of its association with high plasma levels of tissue plasminogen activator inhibitor.[22] Decreased serum HDL levels in young MI patients as compared to healthy controls were also observed by Singh et al.[26]

Hyperlipidemia is a major risk factor for development and progression of MI in young population.[22],[27] Hyperlipidemia is defined as elevated fasting concentration of total cholesterol or triglycerides or undergoing treatment for the same: fasting serum low-density lipoprotein (LDL) >130 mg/dL, total cholesterol: high-density lipoprotein (HDL) ratio >4.5, or non-HDL cholesterol >160 mg/dL.[17],[21],[22] Hyperlipidemia is present approximately in 50% of these young MI patients.[17],[21] Familial combined hyperlipidemia is associated with increased cases of MI in young individuals. Wiesbauer et al. reported a prevalence of 38% of familial combined hyperlipidemia in these patients.[28] Young MI patients had reported increased endogenous cholesterol synthesis alonwith higher non-HDL cholesterol.[18]

Lipoprotein (a), ApoB levels, and ApoB/ApoA1 were also significantly increased in the cases. On the other hand, ApoA1 levels were significantly decreased in the patients. LTI and LPI were significantly increased in the acute MI cases as compared to controls (46433.98 ± 70314.4 vs. 12940.7 ± 7768.2, P < 0.0001, and 1459906.59 ± 2298888.1 vs. 412972.93 ± 70667.2, P < 0.0001), respectively, as shown in [Table 2] and [Table 3].

ApoB and ApoA1 are the main surface proteins of LDL and HDL particles, respectively. ApoB/ApoA1 ratio has been demonstrated to have a strong association with MI.[30] Significantly elevated LTI in young MI patients was also reported by Senthilkumari et al.[25] The increased concentration of atherogenic lipoproteins plays an important role in the development of atherosclerosis leading to premature MI and stroke. Snehalatha et al. reported that ApoB and ApoA-I were strongly related to angiographically proven CHD in Asian Indians with diabetes.[31] It has been stated that decreased levels of ApoA-I and HDL-C have a significant effect on mortality due to cardiac disease.[32]

Lp(a) is synthesized in liver is an atherogenic lipoprotein which is mainly responsible for development of premature CHD. Lp(a) particles contain Apo (a) and ApoB100 in a 1:1 molar ratio. Lp(a) concentration in plasma varies 1000-fold in human population ranging from undetectable to >100 mg/dl, and difference is primarily due to production rather than catabolism of the particle.[34] Plasma levels of Lp(a) do not vary with the age and are fully expressed in the 1st year of life.[8] Raised Lp(a) was found in young adults with a parental history of premature MI.[35] Lp(a) along with increased triglyceride, increased LDL-C, and decreased HDL-C is known as deadly lipid quartet. These biochemical parameters are considered as a strong predictor of occurrence of CAD.[36] Levels of LTI <10,000 mg/dL are considered as desirable, >20,000 considered as high, and >100,000 considered as risk factor for occurrence of premature and high-risk CAD.[37] The present study showed LTI more than 20,000 mg/dL in 76 (56.2%) patients of young MI [Table 4].

On correlating lipid parameters with LTI, a significant positive correlation was observed with all lipid parameters – total cholesterol, triglyceride, LDL-C, Lp(a), and ApoB/ApoA1 (P < 0.0001, P < 0.0001, P < 0.001, P < 0.0001, and P < 0.0001, respectively) except HDL-C which showed a significantly negative correlation (P < 0.01) with LTI. Whereas on correlating with LPI, a significant positive correlation was observed with total cholesterol, triglyceride, LDL-C, Lp(a), and ApoB/ApoA1 (P < 0.0001, P < 0.0001, P < 0.0001, P < 0.0001, and P < 0.0001, respectively) as shown in [Table 5] and [Figure 5] and [Figure 6]. HDL-C also showed a negative correlation with LPI but was not significant statistically (P > 0.05). This correlation of lipid parameters with LTI and LPI indicates that the risk of CAD increases exponentially with combined changes in these parameters. LTI facilitates in early identification of individuals with high risk for premature CAD as a result of their genetic predisposition.[25]
Table 5: Correlation of lipid tetrad index and lipid pentad index with conventional lipid parameters

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Figure 5: Significantly negative correlation of high-density lipoprotein with atherogenic index of plasma in controls

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Figure 6: Significantly negative correlation of high-density lipoprotein with atherogenic index of plasma in cases

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The present study showed a significantly negative correlation of HDL with AIP in both cases and controls [Table 6], [Figure 4] and [Figure 5]. AIP value under 0.11 is considered as a low risk of CVD and values between 0.11 and 0.21 as intermediate risk and above 0.21 associates with high risk of CVDs. Our study reported that out of 135 cases, 2 patients had AIP <0.11 and 4 had between 0.11 and 0.21 and the rest 129 cases had AIP >0.21. Zhu et al. reported AIP as a better biomarker for CAD and type 2 diabetes than the conventional lipids.[10] Patients in the highest quintile of the TG/HDL-C ratio had a 16-fold increased risk of MI compared with the lowest quintile. Higher TG/HDL-C ratio was also a strong independent predictor of cardiovascular mortality in female patients referred for clinically indicated coronary angiography. Although the exact mechanism by which a higher AIP affects the increased risk of all-cause and cardiovascular mortality remains unclear, the association of AIP with LDL-C particle size, insulin resistance, and metabolic syndrome can be possible explanations.[38]
Table 6: Correlation of atherogenic index of plasma with other lipid parameters

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Figure 4: Lipid pentad index in cases and controls

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AIP has been shown as a marker of plasma atherogenicity because of its strong and positive association with cholesterol esterification rates, lipoprotein particle size, and remnant lipoproteinemia.[39],[40],[41] It has been shown to be more closely related to cardiovascular risk than individual lipoprotein cholesterol fractions or other atherogenic indices.[42],[43] High levels of the triglyceride-to-HDL-C ratio have been associated with obesity and metabolic syndrome.[44],[45] Hypertriglyceridemia stimulates the activity of cholesteryl ester transfer protein, which exchanges triglycerides from triglyceride-rich lipoproteins for cholesteryl esters from high- and LDLs;[46] triglyceride enrichment of high- and LDL particles renders them better substrates for lipolysis by hepatic lipase, resulting in HDL catabolism and elimination of denser LDL particles. Increased ratio of triglycerides to HDL-C was associated with an increasingly atherogenic lipid phenotype, characterized by higher remnant lipoprotein particle cholesterol along with higher non-HDL-C and LDL-C density. Millán et al.[47] suggested that the simultaneous use of triglyceride-to-HDL-C ratio is more useful than isolated lipid values as it more closely reflects the complex interactions of lipoprotein metabolism and can better predict plasma atherogenicity.


  Conclusion Top


This present study has evaluated Role of AIP along with lipid indices such as LTI & LPI which helps in early identification of individuals with higher risk of premature CAD. AIP can be used as a better biomarker than other lipid indices in young MI patients, especially those associated with cardiovascular risk, as higher AIP levels showed association with other risk factors of CVDs and changes in these risk factors might affect AIP index. At present, no Lp(a)-lowering drugs have been approved, hence early identification and intervention to modify risk factor may be helpful in prevention of development of MI in these patients with the help of LTI and LPI levels.

Financial support and sponsorship

Nil.

Conflicts of interest

The authors declare that none of the authors have any competing interests.



 
  References Top

1.
Srinath Reddy K, Shah B, Varghese C, Ramadoss A. Responding to the threat of chronic diseases in India. Lancet 2005;366:1744-9.  Back to cited text no. 1
    
2.
Joshi P, Islam S, Pais P, Reddy S, Dorairaj P, Kazmi K, et al. Risk factors for early myocardial infarction in South Asians compared with individuals in other countries. JAMA 2007;297:286-94.  Back to cited text no. 2
    
3.
Myocardial Infarction. (2018); 2019. Available from: https://emedicine.medscape.com/article/155919-overview. [Last accessed on 2019 Mar 07].  Back to cited text no. 3
    
4.
Leading Causes of Death; 2017. Available from: https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm. [Last accessed on 2019 Mar 07].  Back to cited text no. 4
    
5.
Harikrishnan S, Leeder S, Huffman M, Jeemon P, Prabhakaran D. A Race Against Time: The Challenge of Cardiovascular Disease in Developing Economies. 2nd ed. New Delhi, India: New Delhi Centre for Chronic Disease Control; 2014. p. 1-36.  Back to cited text no. 5
    
6.
Kumar N, Kumar S, Kumar A, Shakoor T, Rizwan A. Lipid profile of patients with acute myocardial infarction (AMI). Cureus 2019;11:e4265.  Back to cited text no. 6
    
7.
Tanne D, Koren-Morag N, Graff E, Goldbourt U. Blood lipids and first-ever ischemic stroke/transient ischemic attack in the Bezafibrate Infarction Prevention (BIP) Registry: High triglycerides constitute an independent risk factor. Circulation 2001;104:2892-7.  Back to cited text no. 7
    
8.
Das B, Daga MK, Gupta SK. Lipid Pentad Index: A novel bioindex for evaluation of lipid risk factors for atherosclerosis in young adolescents and children of premature coronary artery disease patients in India. Clin Biochem 2007;40:18-24.  Back to cited text no. 8
    
9.
Morais CA, Oliveira SH, Lima LM. Lipid Tetrad Index (LTI) and Lipid Pentad Index (LPI) in healthy subjects. Arq Bras Cardiol 2013;100:322-7.  Back to cited text no. 9
    
10.
Zhu X, Yu L, Zhou H, Ma Q, Zhou X, Lei T, et al. Atherogenic index of plasma is a novel and better biomarker associated with obesity: A population-based cross-sectional study in China. Lipids Health Dis 2018;17:37.  Back to cited text no. 10
    
11.
Krumholz HM, Normand SL, Wang Y. Trends in hospitalizations and outcomes for acute cardiovascular disease and stroke, 1999-2011. Circulation 2014;130:966-75.  Back to cited text no. 11
    
12.
Yeh RW, Sidney S, Chandra M, Sorel M, Selby JV, Go AS. Population trends in the incidence and outcomes of acute myocardial infarction. N Engl J Med 2010;362:2155-65.  Back to cited text no. 12
    
13.
Mohan H. Textbook of Pathology. Foreword by Ivan Danjanov. 5th ed. Tunbridge Wells: Anshan Publishers; 2005. p. 305-26.  Back to cited text no. 13
    
14.
George MG, Tong X, Kuklina EV, Labarthe DR. Trends in stroke hospitalizations and associated risk factors among children and young adults, 1995-2008. Ann Neurol 2011;70:713-21.  Back to cited text no. 14
    
15.
Gupta A, Wang Y, Spertus JA, Geda M, Lorenze N, Nkonde-Price C, et al. Trends in acute myocardial infarction in young patients and differences by sex and race, 2001 to 2010. J Am Coll Cardiol 2014;64:337-45.  Back to cited text no. 15
    
16.
Doughty M, Mehta R, Bruckman D, Das S, Karavite D, Tsai T, et al. Acute myocardial infarction in the young – The University of Michigan experience. Am Heart J 2002;143:56-62.  Back to cited text no. 16
    
17.
Aggarwal A, Aggarwal S, Goel A, Sharma V, Dwivedi S. A retrospective case-control study of modifiable risk factors and cutaneous markers in Indian patients with young coronary artery disease. JRSM Cardiovasc Dis 2012;1. doi:10.1258/cvd.2012.012010.  Back to cited text no. 17
    
18.
Goliasch G, Oravec S, Blessberger H, Dostal E, Hoke M, Wojta J, et al. Relative importance of different lipid risk factors for the development of myocardial infarction at a very young age (≤ 40 years of age). Eur J Clin Invest 2012;42:631-6.  Back to cited text no. 18
    
19.
McManus DD, Piacentine SM, Lessard D, Gore JM, Yarzebski J, Spencer FA, et al. Thirty-year (1975 to 2005) trends in the incidence rates, clinical features, treatment practices, and short-term outcomes of patients<55 years of age hospitalized with an initial acute myocardial infarction. Am J Cardiol 2011;108:477-82.  Back to cited text no. 19
    
20.
Shah N, Kelly AM, Cox N, Wong C, Soon K. Myocardial Infarction in the “Young”: Risk Factors, Presentation, Management and Prognosis. Heart Lung Circ 2016;25:955-60.  Back to cited text no. 20
    
21.
Chan CM, Chen WL, Kuo HY, Huang CC, Shen YS, Choy CS, et al. Circadian variation of acute myocardial infarction in young people. Am J Emerg Med 2012;30:1461-5.  Back to cited text no. 21
    
22.
Chan MY, Woo KS, Wong HB, Chia BL, Sutandar A, Tan HC. Antecedent risk factors and their control in young patients with a first myocardial infarction. Singapore Med J 2006;47:27-30.  Back to cited text no. 22
    
23.
Oliveira A, Barros H, Azevedo A, Bastos J, Lopes C. Impact of risk factors for non-fatal acute myocardial infarction. Eur J Epidemiol 2009;24:425-32.  Back to cited text no. 23
    
24.
Enas EA, Mohan V, Deepa M, Farooq S, Pazhoor S, Chennikkara H. The metabolic syndrome and dyslipidemia among Asian Indians: A population with high rates of diabetes and premature coronary artery disease. J Cardiometab Syndr 2007;2:267-75.  Back to cited text no. 24
    
25.
Senthilkumari S, Sasivathanam N, Ramadevi M, Thangavelu K. Is lipid tetrad index a promising atherogenic index in acute coronary syndrome? Int J Sci Stud 2016;4:73-7.  Back to cited text no. 25
    
26.
Singh Y, Srivastava S, Ahmad S, Mishra SK, Shirazi N, Raja M, et al. Is lipid tetrad index the strongest predictor of premature coronary artery disease in North India? J Indian Acad Clin Med 2010;11:175-9.  Back to cited text no. 26
    
27.
Incalcaterra E, Caruso M, Lo Presti R, Caimi G. Myocardial infarction in young adults: Risk factors, clinical characteristics and prognosis according to our experience. Clin Ter 2013;164:e77-82.  Back to cited text no. 27
    
28.
Wiesbauer F, Blessberger H, Azar D, Goliasch G, Wagner O, Gerhold L, et al. Familial-combined hyperlipidaemia in very young myocardial infarction survivors (< or=40 years of age). Eur Heart J 2009;30:1073-9.  Back to cited text no. 28
    
29.
Poledne R, Scheithauer E, Bicanová H. Accelerated cholesterol synthesis in the monocytes of young myocardial infarction survivors. Cor Vasa 1993;35:99-101.  Back to cited text no. 29
    
30.
Parish S, Peto R, Palmer A, Clarke R, Lewington S, Offer A, et al. The joint effects of apolipoprotein B, apolipoprotein A1, LDL cholesterol, and HDL cholesterol on risk: 3510 cases of acute myocardial infarction and 9805 controls. Eur Heart J 2009;30:2137-46.  Back to cited text no. 30
    
31.
Snehalatha C, Ramachandran A, Sivasankari S, Satyavani K, Viswanathan V, Misra J, et al. Is increased apolipoprotein B – A major factor enhancing the risk of coronary artery disease in type 2 diabetes? J Assoc Physicians India 2002;50:1036-8.  Back to cited text no. 31
    
32.
Lundstam U, Herlitz J, Karlsson T, Lindén T, Wiklund O. Serum lipids, lipoprotein (a) level, and apolipoprotein (a) isoforms as prognostic markers in patients with coronary heart disease. J Intern Med 2002;251:111-8.  Back to cited text no. 32
    
33.
Hoefler G, Harnoncourt F, Paschke E, Mirtl W, Pfeiffer KH, Kostner GM. Lipoprotein Lp(a). A risk factor for myocardial infarction. Arteriosclerosis 1988;8:398-401.  Back to cited text no. 33
    
34.
Koschinsky ML, Marcovina SM. Lipoprotein (a). In: Ballantye CM, editor. Clinical Lipidology, a Companion to Braunwald's Heart Disease. Ch. 11. Philadelphia, PA: Saunder's Elsevier; 2009. p. 130-5.  Back to cited text no. 34
    
35.
Cuomo S, Guarini P, Gaeta G, De Michele M, Boeri F, Dorn J, et al. Increased carotid intima-media thickness in children-adolescents, and young adults with a parental history of premature myocardial infarction. Eur Heart J 2002;23:1345-50.  Back to cited text no. 35
    
36.
Rajappa M, Sridhar MG, Balachander J, Sethuraman KR. Lipoprotein (a) and comprehensive lipid tetrad index as a marker for coronary artery disease in NIDDM patients in South India. Clin Chim Acta 2006;372:70-5.  Back to cited text no. 36
    
37.
Enas EA. Rapid angiographic progression of coronary artery disease in patients with elevated lipoprotein (a) Circulation 1995;92:2353-4.  Back to cited text no. 37
    
38.
Lee MJ, Park JT, Han SH, Kim YL, Kim YS, Yang CW, et al. The atherogenic index of plasma and the risk of mortality in incident dialysis patients: Results from a nationwide prospective cohort in Korea. PLoS One 2017;12:e0177499.  Back to cited text no. 38
    
39.
Dobiásová M. AIP – Atherogenic index of plasma as a significant predictor of cardiovascular risk: From research to practice. Vnitr Lek 2006;52:64-71.  Back to cited text no. 39
    
40.
Dobiásová M, Frohlich J. The plasma parameter log (TG/HDL-C) as an atherogenic index: Correlation with lipoprotein particle size and esterification rate in apoB-lipoprotein-depleted plasma (FER (HDL)). Clin Biochem 2001;34:583-8.  Back to cited text no. 40
    
41.
Quispe R, Manalac RJ, Faridi KF, Blaha MJ, Toth PP, Kulkarni KR, et al. Relationship of the triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio to the remainder of the lipid profile: The Very Large Database of Lipids-4 (VLDL-4) study. Atherosclerosis 2015;242:243-50.  Back to cited text no. 41
    
42.
Essiarab F, Taki H, Lebrazi H, Sabri M, Saïle R. Usefulness of lipid ratios and atherogenic index of plasma in obese Moroccan women with or without metabolic syndrome. Ethn Dis 2014;24:207-12.  Back to cited text no. 42
    
43.
Edwards MK, Blaha MJ, Loprinzi PD. Atherogenic index of plasma and triglyceride/high-density lipoprotein cholesterol ratio predict mortality risk better than individual cholesterol risk factors, among an older adult population. Mayo Clin Proc 2017;92:680-1.  Back to cited text no. 43
    
44.
González-Chávez A, Simental-Mendía LE, Elizondo-Argueta S. Elevated triglycerides/HDL-cholesterol ratio associated with insulin resistance. Cir Cir 2011;79:126-31.  Back to cited text no. 44
    
45.
Karelis AD, Pasternyk SM, Messier L, St-Pierre DH, Lavoie JM, Garrel D, et al. Relationship between insulin sensitivity and the triglyceride-HDL-C ratio in overweight and obese postmenopausal women: A MONET study. Appl Physiol Nutr Metab 2007;32:1089-96.  Back to cited text no. 45
    
46.
Guérin M, Le Goff W, Lassel TS, Van Tol A, Steiner G, Chapman MJ. Atherogenic role of elevated CE transfer from HDL to VLDL (1) and dense LDL in type 2 diabetes: Impact of the degree of triglyceridemia. Arterioscler Thromb Vasc Biol 2001;21:282-8.  Back to cited text no. 46
    
47.
Millán J, Pintó X, Muñoz A, Zúñiga M, Rubiés-Prat J, Pallardo LF, et al. Lipoprotein ratios: Physiological significance and clinical usefulness in cardiovascular prevention. Vasc Health Risk Manag 2009;5:757-65.  Back to cited text no. 47
    


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