Atherogenic Lipid Indices and the Acute Coronary Syndrome Spectrum: The Modifying Role of Type 2 Diabetes Mellitus, A Cross-Sectional Study

Abstract

Diabetic atherogenic dyslipidemia sustains residual cardiovascular burden in acute coronary syndrome (ACS) poorly reflected by LDL cholesterol. Research on non-traditional lipid indices, AIP, ACI, and LCI, has emphasized coronary disease presence or angiographic severity rather than ACS severity. Whether T2DM modifies this relationship remains unknown. This single-center study included 416 ACS patients (156 with T2DM, 260 without); lipids were sampled within 24 h of admission. AIP, ACI, and LCI were compared across UAP, NSTEMI, and STEMI by glycemic status; ROC cut-offs assessed glycemic status and coronary severity. AIP and LCI were higher in T2DM (P=0.004 and P=0.005), whereas ACI was not (P=0.091). Correlations with spectrum were weak but consistent in T2DM. ACI and LCI differed non-monotonically in the cohort and in T2DM, lowest in UAP and comparable in NSTEMI and STEMI; no index differed in non-diabetic patients. At ROC cut-offs, indices were associated with T2DM within NSTEMI (LCI OR 3.79) and STEMI, not UAP; none with vessel count. LCI was strongest and consistent. In ACS, ACI and LCI distinguish unstable angina from infarction mainly in T2DM, in a non-monotonic pattern absent in non-diabetic patients, reflecting metabolic rather than anatomical burden. T2DM modifies indices-ACS relationships, with LCI the most consistent marker. These cross-sectional findings require prospective, outcome-based validation.