Hypertension is a common chronic non-communicable disease in clinical practice, and its prevalence is on the rise globally due to population aging and changes in human lifestyles. Prolonged high blood pressure can lead to damage to various target organs such as the heart, brain, kidneys, and retina, severely threatening human health and being a major cause of global disease burden. The left ventricle, as the primary target of end-organ damage, its structural changes are also the pathological basis for the development of many cardiovascular diseases.

This study aims to explore the relationship between the atherogenic index of plasma (AIP) and serum lipoprotein-associated phospholipase A2 (Lp-PLA2) levels and left ventricular hypertrophy (LVH) in patients with primary hypertension.

A total of 167 patients with primary hypertension who visited the Department of Cardiovascular Medicine at the Second Affiliated Hospital of Zhengzhou University from October 2021 to June 2023 were enrolled in this study. Baseline data of the patients were collected, and fasting venous blood biochemical markers were measured. Echocardiograms were conducted within 24 hours of admission to calculate left ventricular mass (LVM) and left ventricular mass index (LVMI). Patients were divided into non-left ventricular hypertrophy (NLVH) group (87 patients) and LVH group (80 patients) based on LVMI. Pearson correlation test and Spearman rank correlation analysis were used to investigate the correlation between serum Lp-PLA2 level, AIP and echocardiographic parameters. Multivariate Logistic regression analysis was used to explore the influencing factors of LVH in hypertensive patients. Receiver operating characteristic (ROC) curve was plotted to explore the diagnostic value of serum Lp-PLA2 level and AIP in hypertensive patients with LVH, and the area under ROC curve (AUC) was calculated.

Patients in the LVH group had higher age, duration of hypertension, levels of N-terminal pro B-type natriuretic peptide (NT-proBNP), high-sensitivity C-reactive protein (hs-CRP), left ventricular posterior wall thickness (LVWPT), interventricular septal thickness (IVST), left ventricular end-diastolic diameter (LVEDd), left atrial end-systolic diameter (LAESd), Lp-PLA2 levels, AIP, LVM, and LVMI compared to the NLVH group (P<0.05). Correlation analysis showed that LVMI was positively correlated with Lp-PLA2, AIP, NT-proBNP, hs-CRP, age, and duration of hypertension (P<0.05). LVWPT was positively correlated with Lp-PLA2, AIP, NT-proBNP, hs-CRP, and duration of hypertension (P<0.05). IVST was positively correlated with Lp-PLA2, AIP, hs-CRP, age, and duration of hypertension (P<0.05). LVEDd was positively correlated with Lp-PLA2, AIP, NT-proBNP, hs-CRP (P<0.05). Multivariate Logistic regression analysis showed that elevated hs-CRP (OR=1.249, 95%CI=1.007-1.548, P=0.043), elevated NT-proBNP (OR=1.009, 95%CI=1.002-1.017, P=0.011), increased AIP (OR=14.557, 95%CI=1.220-173.753, P=0.034), and increased Lp-PLA2 (OR=1.042, 95%CI=1.024-1.059, P<0.001) were risk factors for LVH in hypertensive patients. ROC curve results showed that the AUC for diagnosing hypertension combined with LVH using AIP, Lp-PLA2, and combined testing were 0.649 (95%CI=0.566-0.733), 0.780 (95%CI=0.705-0.854), and 0.804 (95%CI=0.733-0.874), respectively.

Serum Lp-PLA2 levels and AIP are closely related to changes in the morphological structure of the left ventricle. Combined testing of both can aid in the early clinical diagnosis of left ventricular hypertrophy in hypertensive patients, providing guidance for clinical diagnosis and treatment.