ORIGINAL RESEARCH article
Front. Nutr.
Sec. Nutrition and Metabolism
Hypertriglyceridemia as an Independent Predictor of Adverse Prognosis in Female Patients with Acute Myocardial Infarction: A Comprehensive Retrospective Cohort Study
Provisionally accepted
- Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
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Backgroun: Acute myocardial infarction (AMI) has notable sex-specific differences in clinical outcomes. While low-density lipoprotein cholesterol (LDL-C) is a longstanding core for atherosclerotic cardiovascular disease (ASCVD) risk assessment, the prognostic value of hypertriglyceridemia (HTG) in AMI patients—especially its sex-specific impact—remains unclear. This gap is critical as HTG is more common in women but understudied in post-AMI populations. Methods: A retrospective cohort included 850 consecutive AMI patients (412 females, 438 males) admitted to the Seventh Affiliated Hospital of Sun Yat-sen University (Jan 2019–Dec 2024), stratified by HTG (triglycerides ≥2.2 mmol/L). Median follow-up was 2.6 years, with outcomes: all-cause death, heart failure, major adverse cardiovascular events (MACE). Confounding was controlled via multivariate Cox regression, E-value calculation, and 1:1 propensity score matching. HTG's predictive value was assessed via receiver operating characteristic (ROC) curves; post hoc power analysis confirmed ≥80% power (α=0.05) for female all-cause death associations. Results: HTG prevalence was 35.1% overall (females 54.4% vs. males 31.1%). HTG patients had higher all-cause death (18.8% vs. 4.7%), heart failure (20.8% vs. 5.3%), and MACE (21.8% vs. 5.4%). Female HTG patients had the highest event rates (all-cause death 28.4%, heart failure 30.2%, MACE 31.5%), while males with HTG only had higher MACE (11.0% vs. 5.3%). HTG independently predicted all outcomes in females (death HR=3.89, heart failure HR=4.21, MACE HR=4.35) but only weakly associated with male MACE (HR=2.05). E-value (4.2 for female death) and matching (284 patients, female death HR=3.62) validated robustness. Adding HTG improved death prediction (ROC AUC 0.78 vs. 0.73) with net reclassification improvement 0.23. Conclusion: HTG is a strong independent predictor of adverse AMI outcomes, with a far stronger effect in females. Routine triglyceride screening and targeted therapies (e.g., fibrates, icosapent ethyl) are needed for female AMI patients.
Keywords: acute myocardial infarction, Hypertriglyceridemia, sex difference, prognosis, Triglycerides
Received: 29 Aug 2025; Accepted: 28 Nov 2025.
Copyright: © 2025 Ma, Hu, Zhu, Liu and Wu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Yang Wu
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