Unravelling the Role of Apolipoprotein-B, Lipoprotein(a), and Homocysteine in Myocardial Infarction: A Tertiary Hospital Case-Control Analysis

Saranya T; Mekhala K.P.; Hariharan V; Leela P; Thirunavukkarasu Jaishankar

Authors

Saranya T Department of Biochemistry, Karpagam Faculty of Medical Science & Research, Coimbatore, Tamil Nadu, India https://orcid.org/0000-0001-5036-4353
Mekhala K.P. Department of Biochemistry, Karpagam Faculty of Medical Science & Research, Coimbatore, Tamil Nadu, India https://orcid.org/0009-0004-4332-6796
Hariharan V Department of Biochemistry, Karpagam Faculty of Medical Science & Research, Coimbatore, Tamil Nadu, India https://orcid.org/0000-0002-7937-9070
Leela P Department of Biochemistry, Karpagam Faculty of Medical Science & Research, Coimbatore, Tamil Nadu, India https://orcid.org/0009-0008-1796-6940
Thirunavukkarasu Jaishankar Department of Biochemistry, Karpagam Faculty of Medical Science & Research, Coimbatore, Tamil Nadu, India https://orcid.org/0009-0007-9053-1524

Keywords:

apolipoprotein B, Cardiovascular Risk Factors, homo- cysteine, lipoprotein(a), myocardial infarction

Abstract

Objective Cardiovascular disease (CVD) causes approximately 17.9 million deaths globally each year, making it one of the leading causes of mortality. Around 15.00-20.00% of cardiovascular events occur without the presence of traditional risk factors. Some less commonly detected risk factors in CVD patients include hyperhomocysteinemia, metabolic syndrome, lipoprotein(a) (Lp(a)), apolipoprotein B (Apo-B), and elevated procoagulant levels. High levels of homocysteine (Hcy), Lp(a), and Apo-B are linked to an increased risk of myocardial infarction (MI). This study aimed to evaluate the prevalence of elevated Apo-B, Lp(a), and Hcy levels in MI patients from rural areas of Coimbatore District, Tamil Nadu, India.

Methods This case-control study was conducted at a tertiary care hospital from January to December 2021, following institutional ethics committee approval (IHEC/188/BIOCHEMISTRY/2020). Fifty MI patients (aged 30-80 years) and 50 age-sex matched healthy controls were recruited after obtaining informed written consent. Patients with previous MI, CAD, chronic kidney disease, or those on lipid-lowering therapy were excluded. Blood samples were collected under sterile conditions and analyzed for Apo-B, Lp(a) and Hcy using immunoturbidimetric methods. Statistical analysis was performed using SPSS version 24, with independent t-tests and Pearson correlation analysis.

Results The average levels of Apo-B, Lp(a) and Hcy in MI patients were 103.2 ± 5.9, 19.7 ± 1.6, and 29.5 ± 2.5, respectively, significantly higher than in the control group. A t-test confirmed a strong association between these risk markers and MI (p = 0.000), indicating their significant role in MI occurrence. ROC curve analysis demonstrated excellent discriminatory ability for Hcy (AUC = 0.868, sensitivity 85%, specificity 90%) with an optimal cut-off of 25 µmol/L.

Conclusions Our findings confirm a strong association between elevated Apo-B, Hcy, and Lp(a) levels and the onset of first-episode MI, especially in patients without prior CVD or lipid-lowering treatment. This underscores the importance of screening for these risk factors, particularly in underserved rural populations, to enhance early detection and preventive care.

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