HIGH TROPONIN, LOW HDL: UNRAVELING THE METABOLIC PARADOX IN ACUTE CORONARY SYNDROME PATIENTS

Objective: To evaluate the correlation between high troponin levels and metabolic markers (HbA1c, LDL, and HDL) in patients presenting with Acute Coronary Syndrome (ACS). Methods: This cross-sectional study was conducted at Peshawar Institute of Cardiology. A total of 182 patients diagnosed with ACS and elevated troponin were enrolled through non-probability convenience sampling. Venous blood samples were analyzed for troponin (via Chemiluminescent Immunoassay), lipid profile, and HbA1c (via spectrophotometry). Statistical analysis included Pearson correlation, Chi-square tests, and subgroup analyses. Results: The study population comprised 124 (68.1%) males and 58 (31.9%) females, with a mean age of 60.1 ± 12.4 years. Elevated HbA1c (≥6.5%) was observed in 83 (45.6%) patients. Pearson correlation showed no significant association between troponin and HbA1c (r=0.068, p=0.361). Regarding lipid profile, 71 (39.0%) patients had elevated LDL, while 81 (44.5%) had decreased HDL. Patients with low HDL demonstrated disproportionately high troponin values, particularly at extreme elevations (>50,000 ng/L), where 92.9% had normal LDL but low HDL. Chi-square analysis revealed no statistically significant association between LDL categories and troponin levels when stratified by HDL status (p>0.05). Conclusion: While no statistically significant linear correlation is observed between troponin and metabolic markers in ACS patients, the observed pattern of extreme troponin elevations in low-HDL patients suggests that HDL may modulate myocardial injury severity. These findings highlight the complex pathophysiology of ACS beyond traditional risk factors.