Periconceptional ambient temperature and adult atherogenic lipid profile: a life-course study in patients with acute coronary syndrome
A Meseguer Hernandez, J M A Cayuelas, F B Santiago, L R Eres, M B V Heredia, J M Romero, M I B Maturano, I G Fernandez, C A A San Segundo, M G Pinana, F S Lopez, A G Montoya, A F Reina, L M Gascon, J A C MorenoAbstract
Background
Recent studies suggest that warmer ambient temperatures at the time of conception may be associated with a reduced activity of brown adipose tissue (BAT) in healthy adults. Reduced BAT activity is linked to higher triglyceride (TG) and lower high-density lipoprotein cholesterol (HDL-C) levels.
Purpose
To investigate in patients with acute coronary syndrome (ACS), the association between periconceptional temperature and the Atherogenic Index of Plasma (AIP), a marker of established prognostic value in this context.
Methods
We analysed 967 consecutive Spanish patients admitted for ACS in our centre, with confirmed coronary disease and in-hospital TG and HDL-C measurements between July 2023 and January 2026. Individual data were linked with historical climatological records of our region (reference years: 1991-2020) to estimate the mean temperature and diurnal temperature range (DTR) during the month of conception (estimated as date of birth minus 266 days). The AIP was calculated as log10(TG/HDL-C). Multiple linear regression models were used to test whether summer conception or mean temperature and DTR were independent predictors of adult AIP. The models were adjusted for age, sex, diabetes, active smoking, body mass index (BMI), cholesterol lowering therapies (statin, ezetimibe or bempedoic acid), fibrates or eicosapentaenoic acid (EPA) treatment and mean temperature on the day of admission.
Results
Patients conceived in summer (n = 236) had a higher AIP on admission compared to those conceived during the rest of the year, although the difference was not statistically significant (0.176 ± 0.312 vs 0.141 ± 0.263; p=0.085). A visually bimodal pattern was observed, with higher AIP values also in late winter (February - March), coinciding with a wide DTR (Figure). In the multivariate analysis, summer conception was independently associated with higher AIP (β=0.039; p=0.039). Furthermore, higher mean temperature (β=0.007 per ºC; p=0.018) and wider DTR (β=0.094 per ºC; p=0.019) during the conception month were significantly associated with a higher AIP at ACS admission. Other predictors of higher AIP were admission at younger age, male sex, diabetes, active smoking, higher BMI, and previous treatment with fibrates or EPA (Table).
Conclusion
Conception during periods of higher ambient temperature and wider diurnal temperature range is associated with a more pro-atherogenic lipid profile decades later in ACS patients. These findings support early metabolic programming as a potential determinant of lifelong cardiovascular risk and may have implications for risk stratification in the context of climate change, although residual confounding related to birth date cannot be excluded.FigureTable