Elevated ASGR1 as a Potential Diagnostic Biomarker for Coronary Artery Disease and Predictor of Adverse Outcomes in Hypertensive Patients.

Asialoglycoprotein receptor 1 (ASGR1) is associated with lipid metabolism and coronary artery disease (CAD) risk, but its expression patterns, diagnostic performance, and prognostic significance in hypertensive patients with CAD remain unelucidated. This single-center study enrolled 345 hypertensive patients between 2022 and 2025 (59 with hypertension alone, 286 with hypertension and CAD). Plasma ASGR1 levels were measured by enzyme-linked immunosorbent assay. Receiver operating characteristic (ROC) curves, Spearman correlation, and Cox proportional hazards modeling were performed to assess the diagnostic efficacy of ASGR1 in CAD and its prognostic value for all-cause rehospitalization. Plasma ASGR1 levels were significantly higher in hypertensive patients with CAD than in those with hypertension alone (p < 0.001) and higher ASGR1 expression is accompanied by more severe coronary lesions and adverse clinical phenotypes. Inflammatory markers, liver injury biomarkers and cardiac injury biomarkers were positively correlated with ASGR1, whereas high-density lipoprotein cholesterol (HDL-C) was negatively correlated. ASGR1 showed excellent diagnostic ability for CAD in hypertensive patients with area under the curve of 0.937 (95% CI: 0.906-0.960). Multivariate analysis showed that each 1-unit increase in ASGR1 was associated with a 37% higher risk of CAD (odds ratio 1.37, 95% CI: 1.24-1.52, p < 0.001). Longitudinally, elevated baseline ASGR1 was independently associated with an increased risk of all-cause rehospitalization (adjusted hazard ratio 1.97, 95% CI: 1.16-3.35, p = 0.012). These findings support ASGR1 may serve as a diagnostic biomarker and prognostic indicator for hypertensive patients with CAD.