Synergistic Effects of Diabetes, Inflammatory/Coagulopathy Biomarkers, TG and Hypoxic Stress on Premature Coronary Heart Disease in High-Altitude Populations

Background: Risk profiles of premature coronary heart disease (PCHD, ≤45 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 2022–30 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 < 0.05). They had significantly higher CHOL, TG, LDL-C, UA and Hb (all p < 0.05), accompanied by lower WBC, PLT and D-dimer (all p < 0.001). Multivariate regression confirmed diabetes mellitus (OR = 1.158, p = 0.014), TG (OR = 1.625, p < 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.