Prognostic value of gut microbiota and low-density lipoprotein cholesterol subfractions in patients with ST-segment elevation myocardial infarction

Siliang Xia¹Yun Liu¹Mengzhu Wang²Dandan Liu¹Xiaobing Zhang¹Lin Ling²Ming Wen²Shushen Ji²Jiaying Li³Xiangming Zhang¹Huihui Jiang^2*

• ¹Department of Cardiology, Nanjing Jiangbei Hospital, Nanjing, China
• ²Shanghai Biotecan Pharmaceuticals Co., Ltd., Shanghai, China
• ³Teaching Research Department, Changji Branch of the First Affiliated Hospital of Xinjiang Medical University, Changji, China

Objective: Gut dysbiosis and the distribution of low-density lipoprotein cholesterol (LDL-C) subfractions have been implicated in cardiovascular risk among patients with STsegment elevation myocardial infarction (STEMI). However, the prognostic significance of LDL-C subfractions in relation to gut microbiota composition remains largely unexplored.This study aimed to assess differences in gut microbiota profiles and LDL-C subfraction distribution between patients with STEMI with and without major adverse cardiovascular events (MACEs) and to elucidate their potential interplay.Methods: We enrolled 32 male population without coronary heart disease and 66 male patients with STEMI. Fecal samples were analyzed via 16S rDNA gene sequencing to assess gut microbiota diversity and composition. Plasma LDL-C subfractions were quantified using the Quantimetrix Lipoprint LDL System.Results: Among these 66 STEMI patients, 18 experienced MACEs during a median followup of 13 months (MACEs group), while 18 age-matched event-free patients were selected as controls (Non-MACEs group). Significant differences in gut microbiota composition, but not diversity, were observed between the two groups, with the Non-MACEs group exhibiting a greater number of marker genera. Although no significant differences were found in LDL-C subfractions between groups, multiple significant negative correlations were identified between gut microbiota and LDL-C subfractions in the MACEs group, including between Coprococcus and LDLC-4 (ρ=-0.5488, P<0.05), between Coprococcus and LDLC-5 (ρ=-0.6418, P<0.01), between Coprococcus and LDLC-6 (ρ=-0.4988, P<0.05), between UCG-002 and LDLC-4 (ρ=-0.4948, P<0.05), and betweenChristensenellaceae_R-7_group and LDLC-4 (ρ=-0.5032, P<0.05). Furthermore, gut microbiota markers demonstrated superior predictive performance for MACEs compared to LDL-C subfractions, with UCG-002, Christensenellaceae_R-7_group, andNK4A214_group achieving AUC values >0.75.Gut microbiota, particularly UCG-002, Christensenellaceae_R-7_group, andNK4A214_group, exhibit greater prognostic potential for MACEs than LDL-C subfractions.These findings highlight the role of gut microbiota in post-STEMI risk stratification, underscoring its potential as a target for future cardiovascular interventions.