Lipid tetrad index –a new risk calculator in acute coronary syndrome

Introduction: CAD is a chronic process that begins during adolescence and slowly progresses throughout life. Since the underlying etiology of CHD is multifactorial, it is therefore, unlikely that a single biomarker will provide accurate information for CAD occurrence. Hence, the present study is on simultaneous measurement of several lipid biomarkers and calculation of lipid tetrad index (LTI). This index eliminates the need for numerous ratios and cutoff points that are confusing and frustrating for the clinicians. The LTI is derived by multiplying three lipids which are directly associated with CAD and dividing the product by high-density lipoprotein (HDL) which is inversely associated with CAD. Material and Methods: THIS hospital based prospective case control study was conducted in wards and ICU of department of medicine and cardiology of M. B. Govt. Hospital, Udaipur from June, 2021 to June, 2022 over a period of 1 year. 120 patients from wards or ICU with ACS were selected based on the inclusion/exclusion criteria and 120 normal subjects were taken from relatives of patients and healthy volunteers. Fasting venous blood samples were collected and sent for lipid profile and lipoprotein (a) estimation and Lipid Tetrad Index was calculated. Qualitative data collected were entered in Microsoft excel software and analyzed using SPSS, version 21 for Windows statistical software package. Result: In our study, there was no significant difference between two groups. 65 percent were males, and 35% were females in both control and study groups. The mean HDL (36.48 vs 40.32) is lower in study group compared to control group which is significant. The mean plasma Lp(a) is greater in study group compared to the control group (37.70 vs 24.13 mg/dl ). LTI values in study group are greater compared to control group for their respective age distribution and are statistically significant (24423.60 vs 11807.43). The mean plasma TC, TGL, LDL are greater in study group compared to the control group. Conclusion: Thus in our study it is concluded that there is a highly significant positive correlation between the LTI and Lp(a) levels. There is statistically significant negative correlation between LTI and the HDL. Thus, the effect of various lipid parameters as well as Lp-a on the atherogenicity is not additive but multiplicative which is well demonstrated by the lipid tetrad index