{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T15:38:55Z","timestamp":1786117135897,"version":"build-2736575974"},"reference-count":40,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T00:00:00Z","timestamp":1785974400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Xizang Natural Science Foundation, Group Medical Aid to Xizang Medical Project Funding","award":["XZZR202402133(W)"],"award-info":[{"award-number":["XZZR202402133(W)"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Cardiovasc. Dev. Dis.","JCDD"],"abstract":"<jats:p>Background: Risk profiles of premature coronary heart disease (PCHD, \u226445 years) among high-altitude acute coronary syndrome (ACS) populations remain poorly characterized. This study explored clinical features and independent predictors of early-onset ACS in Lhasa. Methods: We retrospectively enrolled 467 first-ACS patients (1 July 2022\u201330 June 2024). Patients were further dichotomized into PCHD and non-PCHD groups for comparison. Univariable and multivariable logistic regression identified PCHD risk factors. Results: Compared with non-PCHD patients, PCHD patients featured higher proportions of male non-Tibetans, higher smoking and alcohol consumption rates, lower prevalence of hypertension and diabetes, and elevated SpO2 (all p &lt; 0.05). They had significantly higher CHOL, TG, LDL-C, UA and Hb (all p &lt; 0.05), accompanied by lower WBC, PLT and D-dimer (all p &lt; 0.001). Multivariate regression confirmed diabetes mellitus (OR = 1.158, p = 0.014), TG (OR = 1.625, p &lt; 0.001), WBC (OR = 1.995, p = 0.007), D-dimer (OR = 2.841, p = 0.043) and SpO2 (OR = 0.937, p = 0.019) as independent predictors of PCHD. Conclusions: Integrated monitoring of glucose, lipids, hypoxia and thromboinflammatory biomarkers may supply preliminary auxiliary reference for early prevention of PCHD in local highland youth, while large multi-center verification is still needed to confirm its clinical value.<\/jats:p>","DOI":"10.3390\/jcdd13080372","type":"journal-article","created":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T13:03:27Z","timestamp":1786021407000},"page":"372","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Synergistic Effects of Diabetes, Inflammatory\/Coagulopathy Biomarkers, TG and Hypoxic Stress on Premature Coronary Heart Disease in High-Altitude Populations"],"prefix":"10.3390","volume":"13","author":[{"given":"Jianbo","family":"Yu","sequence":"first","affiliation":[{"name":"Emergency Department, Xizang Autonomous Region People\u2019s Hospital, Lhasa 850000, China"},{"name":"Emergency Department, Peking University People\u2019s Hospital, Beijing 100044, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danzeng","family":"Quzhen","sequence":"additional","affiliation":[{"name":"Emergency Department, Xizang Autonomous Region People\u2019s Hospital, Lhasa 850000, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luosang","family":"Quzhen","sequence":"additional","affiliation":[{"name":"Emergency Department, Xizang Autonomous Region People\u2019s Hospital, Lhasa 850000, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peiliang","family":"Gao","sequence":"additional","affiliation":[{"name":"Emergency Department, Peking University People\u2019s Hospital, Beijing 100044, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jue\u2019a","family":"Ciren","sequence":"additional","affiliation":[{"name":"Emergency Department, Xizang Autonomous Region People\u2019s Hospital, Lhasa 850000, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xueying","family":"Fu","sequence":"additional","affiliation":[{"name":"Emergency Department, Peking University People\u2019s Hospital, Beijing 100044, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jihong","family":"Zhu","sequence":"additional","affiliation":[{"name":"Emergency Department, Peking University People\u2019s Hospital, Beijing 100044, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-0947-6402","authenticated-orcid":false,"given":"Zhenzhong","family":"Yang","sequence":"additional","affiliation":[{"name":"Emergency Department, Xizang Autonomous Region People\u2019s Hospital, Lhasa 850000, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guiying","family":"Dong","sequence":"additional","affiliation":[{"name":"Emergency Department, Xizang Autonomous Region People\u2019s Hospital, Lhasa 850000, China"},{"name":"Emergency Department, Peking University People\u2019s Hospital, Beijing 100044, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e1489","DOI":"10.1016\/S2214-109X(20)30358-2","article-title":"Burden of non-communicable diseases from infectious causes in 2017: A modelling study","volume":"8","author":"Coates","year":"2020","journal-title":"Lancet Glob. Health"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e0282","DOI":"10.1590\/0037-8682-0282-2021","article-title":"Burden of non-communicable diseases attributable to dietary risks in Brazil, 1990\u20132019: An analysis of the Global Burden of Disease Study 2019","volume":"55","author":"Machado","year":"2022","journal-title":"Rev. Soc. Bras. Med. Trop."},{"key":"ref_3","unstructured":"National Health and Family Planning Commission Rational Drug Use Expert Committee CPA (2018). Guidelines for Rational Drug Use in Coronary Heart Disease (2nd Edition). J. Chin. Med. Front. Electron. Ed., 10, 1\u2013130."},{"key":"ref_4","first-page":"3251","article-title":"Age-related coronary risk factors in Chinese patients with acute myocardial infarction","volume":"96","author":"Gao","year":"2016","journal-title":"Zhonghua Yi Xue Za Zhi"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1016\/j.ijcard.2007.02.038","article-title":"Premature myocardial infarction: Clinical profile and angiographic findings","volume":"126","author":"Pineda","year":"2008","journal-title":"Int. J. Cardiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1868","DOI":"10.1016\/j.jacc.2019.08.1002","article-title":"Long-Term Evolution of Premature Coronary Artery Disease","volume":"74","author":"Collet","year":"2019","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2431","DOI":"10.1016\/j.jacc.2022.04.015","article-title":"Causes, Angiographic Characteristics, and Management of Premature Myocardial Infarction: JACC State-of-the-Art Review","volume":"79","author":"Rallidis","year":"2022","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e017712","DOI":"10.1161\/JAHA.120.017712","article-title":"Risk Factor Burden and Long-Term Prognosis of Patients with Premature Coronary Artery Disease","volume":"9","author":"Zeitouni","year":"2020","journal-title":"J. Am. Heart Assoc."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1016\/j.hlc.2023.12.012","article-title":"Modifiable and Non-Modifiable Risk Factors for Premature Coronary Heart Disease (PCHD): Systematic Review and Meta-Analysis","volume":"33","author":"Khoja","year":"2024","journal-title":"Heart Lung Circ."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1001\/jamacardio.2022.4887","article-title":"Cardiovascular Disease Risk Prediction in Young Adults\u2014The Next Frontier","volume":"8","author":"Khan","year":"2023","journal-title":"JAMA Cardiol."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Sun, J., Qiao, Y., Zhao, M., Magnussen, C.G., and Xi, B. (2023). Global, regional, and national burden of cardiovascular diseases in youths and young adults aged 15\u201339 years in 204 countries\/territories, 1990\u20132019: A systematic analysis of Global Burden of Disease Study 2019. BMC Med., 21.","DOI":"10.1186\/s12916-023-02925-4"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Li, M., Guo, J., Zhao, M., Han, Y., Ji, F., and Liu, Z. (2026). High-altitude thrombosis: Divergent pathophysiological mechanisms and preventive strategies in acutely exposed population and native highlanders. Front. Cardiovasc. Med., 13.","DOI":"10.3389\/fcvm.2026.1752475"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"3720","DOI":"10.1093\/eurheartj\/ehad191","article-title":"2023 ESC Guidelines for the management of acute coronary syndromes","volume":"44","author":"Byrne","year":"2023","journal-title":"Eur. Heart J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1879","DOI":"10.1016\/j.jacc.2019.08.1023","article-title":"Coronary Artery Disease in Young Adults: A Hard Lesson But a Good Teacher","volume":"74","author":"Michos","year":"2019","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1040","DOI":"10.2174\/0109298673303891240528114755","article-title":"Early-onset or Premature Coronary Artery Disease","volume":"32","author":"Manolis","year":"2025","journal-title":"Curr. Med. Chem."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1097\/MCA.0000000000001141","article-title":"Premature acute coronary syndrome: Understanding the early onset","volume":"33","author":"Mota","year":"2022","journal-title":"Coron. Artery Dis."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1001\/jama.2022.0358","article-title":"Diagnosis and Treatment of Acute Coronary Syndromes: A Review","volume":"327","author":"Bhatt","year":"2022","journal-title":"JAMA"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1186\/s13293-017-0152-8","article-title":"The protective role of estrogen and estrogen receptors in cardiovascular disease and the controversial use of estrogen therapy","volume":"8","author":"Iorga","year":"2017","journal-title":"Biol. Sex. Differ."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1186\/s13019-026-03975-4","article-title":"Distinct clinical profiles and outcomes in young versus older adults with acute coronary syndrome: A comparative cohort study","volume":"21","author":"Wang","year":"2026","journal-title":"J. Cardiothorac. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1186\/s12944-024-02412-6","article-title":"The role of the triglyceride-glucose index as a biomarker of cardio-metabolic syndromes","volume":"23","author":"Gounden","year":"2024","journal-title":"Lipids Health Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1186\/s12933-024-02290-3","article-title":"Association of triglyceride-glucose index and its related parameters with atherosclerotic cardiovascular disease: Evidence from a 15-year follow-up of Kailuan cohort","volume":"23","author":"Xia","year":"2024","journal-title":"Cardiovasc. Diabetol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1186\/s12933-019-0982-2","article-title":"Use of the triglyceride-glucose index (TyG) in cardiovascular disease patients","volume":"19","author":"Alizargar","year":"2020","journal-title":"Cardiovasc. Diabetol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e012178","DOI":"10.1161\/JAHA.119.012178","article-title":"Premature Atherosclerotic Cardiovascular Disease: Trends in Incidence, Risk Factors, and Sex-Related Differences, 2000 to 2016","volume":"8","author":"Vikulova","year":"2019","journal-title":"J. Am. Heart Assoc."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/j.carrev.2016.01.005","article-title":"Serum biomarkers and source of inflammation in acute coronary syndromes and percutaneous coronary interventions","volume":"17","author":"Centurion","year":"2016","journal-title":"Cardiovasc. Revasc. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"100694","DOI":"10.1016\/j.blre.2020.100694","article-title":"Platelet activation and prothrombotic mediators at the nexus of inflammation and atherosclerosis: Potential role of antiplatelet agents","volume":"45","author":"Lordan","year":"2021","journal-title":"Blood Rev."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Tudurachi, B.S., Anghel, L., Tudurachi, A., Sascau, R.A., and Statescu, C. (2023). Assessment of Inflammatory Hematological Ratios (NLR, PLR, MLR, LMR and Monocyte\/HDL-Cholesterol Ratio) in Acute Myocardial Infarction and Particularities in Young Patients. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms241814378"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1392","DOI":"10.1161\/CIRCRESAHA.116.306853","article-title":"Cross Talk Pathways Between Coagulation and Inflammation","volume":"118","author":"Foley","year":"2016","journal-title":"Circ. Res."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"666","DOI":"10.1038\/s41569-021-00552-1","article-title":"Interplay between inflammation and thrombosis in cardiovascular pathology","volume":"18","author":"Stark","year":"2021","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Busco, M., Cappannoli, L., Bianchini, F., Aurigemma, C., Casamassima, F., Cicchella, D., Marchetta, M., Paglianiti, D.A., Fracassi, F., and Buffon, A. (2026). Risk factors and clinical presentation of coronary artery disease in young patients: A decade-long single-center experience. BMC Cardiovasc. Disord., 26.","DOI":"10.1186\/s12872-026-05729-5"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Juan-Salvadores, P., Jimenez Diaz, V.A., Iglesia Carreno, C., Guitian Gonzalez, A., Veiga, C., Martinez Reglero, C., Alonso, J.A.B., Isorna, F.C., and Romo, A.I. (2022). Coronary Artery Disease in Very Young Patients: Analysis of Risk Factors and Long-Term Follow-Up. J. Cardiovasc. Dev. Dis., 9.","DOI":"10.3390\/jcdd9030082"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"720","DOI":"10.1159\/000519468","article-title":"Association of Polycythemia with Outcomes of Acute Coronary Syndrome","volume":"146","author":"Marcus","year":"2021","journal-title":"Cardiology"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1152\/physiol.00018.2014","article-title":"King of the mountains: Tibetan and Sherpa physiological adaptations for life at high altitude","volume":"29","author":"Milledge","year":"2014","journal-title":"Physiology"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"11459","DOI":"10.1073\/pnas.1002443107","article-title":"Natural selection on EPAS1 (HIF2alpha) associated with low hemoglobin concentration in Tibetan highlanders","volume":"107","author":"Beall","year":"2010","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1038\/ng.3067","article-title":"A genetic mechanism for Tibetan high-altitude adaptation","volume":"46","author":"Lorenzo","year":"2014","journal-title":"Nat. Genet."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"963","DOI":"10.3357\/ASEM.2085.2007","article-title":"Erythropoietin levels in lowlanders and high-altitude natives at 3450 m","volume":"78","author":"Basu","year":"2007","journal-title":"Aviat. Space Environ. Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2106","DOI":"10.1002\/ajh.70025","article-title":"History of Thrombosis at High Altitude Associates with Increased Erythropoietin","volume":"100","author":"Amaru","year":"2025","journal-title":"Am. J. Hematol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1002\/lipd.12441","article-title":"Lipid and lipoprotein particle profiles in patients with type 2 diabetes mellitus: A comparative study between highlanders and lowlanders","volume":"60","author":"Zhang","year":"2025","journal-title":"Lipids"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Wei, Y., Giunta, S., and Xia, S. (2022). Hypoxia in Aging and Aging-Related Diseases: Mechanism and Therapeutic Strategies. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms23158165"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1182\/blood-2018-04-841585","article-title":"Hypoxia downregulates protein S expression","volume":"132","author":"Pilli","year":"2018","journal-title":"Blood"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Kammerer, T., Faihs, V., Hulde, N., Stangl, M., Brettner, F., Rehm, M., Horstmann, M., Kr\u00f6pfl, J.M., Spengler, C.M., and Kreth, S. (2020). Hypoxic-inflammatory responses under acute hypoxia: In Vitro experiments and prospective observational expedition trial. Int. J. Mol. Sci., 21.","DOI":"10.3390\/ijms21031034"}],"container-title":["Journal of Cardiovascular Development and Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2308-3425\/13\/8\/372\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T13:16:49Z","timestamp":1786022209000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2308-3425\/13\/8\/372"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,6]]},"references-count":40,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["jcdd13080372"],"URL":"https:\/\/doi.org\/10.3390\/jcdd13080372","relation":{},"ISSN":["2308-3425"],"issn-type":[{"value":"2308-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,6]]}}}