Abstract
ObjectiveAcute myocardial infarction is a leading cause of global mortality. Early detection and accurate risk stratification in patients with stable angina pectoris are crucial for improving clinical outcomes. This study aimed to identify novel lipid biomarkers for predicting the risk of acute myocardial infarction in patients with stable angina pectoris using nontargeted lipidomics.MethodsThis cross-sectional study enrolled 260 participants (40 non-cardiovascular disease controls, 180 patients with stable angina pectoris, and 40 patients with acute myocardial infarction) from August 2022 to December 2023. Plasma samples were analyzed via nontargeted lipidomics. Orthogonal partial least squares discriminant analysis was used to assess the differences in lipid profiles between the three groups. Random forest regression was used to identify key lipid metabolites. Independent associations between selected variables and the risks of cardiovascular disease and acute myocardial infarction were assessed using stepwise multivariate logistic regression. Model performance was evaluated using receiver operating characteristic curves.ResultsLipidomic analysis identified two specific phosphatidylethanolamine species, phosphatidylethanolamine(37:4) and phosphatidylethanolamine(17:0/20:4), as progressively elevated from non-cardiovascular disease controls to patients with stable angina pectoris and further to patients with acute myocardial infarction. Notably, in the multivariate models, phosphatidylethanolamine(17:0/20:4) emerged as an independent predictor of acute myocardial infarction risk in patients with stable angina pectoris (odds ratio = 3.13, 95% confidence interval: 1.33-7.38), while phosphatidylethanolamine(37:4) was independently associated with the overall cardiovascular disease risk (odds ratio = 4.01, 95% confidence interval: 1.30-12.38). Integrating these phosphatidylethanolamine species with conventional clinical parameters significantly improved the predictive accuracy for the risks of cardiovascular disease (area under the curve = 0.93) and acute myocardial infarction (area under the curve = 0.88).ConclusionThis study demonstrates the potential of nontargeted lipidomics in discovering novel lipid biomarkers for predicting acute myocardial infarction risk in patients with stable angina pectoris. The identified phosphatidylethanolamine species provide a basis for improving cardiovascular risk stratification and may serve as targets for future therapeutic interventions.