Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 64 9 2026 08 19 564 572 Shatha Hamed Jwaid College of Health and Medical Technologies, Middle Technical University, Baghdad, Iraq Huda Farhan Ahmed College of Health and Medical Technologies, Middle Technical University, Baghdad, Iraq 2026 08 09 2026 08 15 Type 2 diabetes mellitus (T2DM) substantially increases the risk of acute coronary syndrome (ACS) through the combined effects of chronic hyperglycemia, dyslipidemia, oxidative stress, endothelial dysfunction, and myocardial injury. This study aimed to comprehensively evaluate metabolic, oxidative stress, and cardiac biomarkers in patients with T2DM complicated by ACS, and to investigate their diagnostic performance and interrelationships. A case-control study was conducted including 60 patients with T2DM complicated by ACS and 30 apparently healthy controls. Fasting blood glucose (FBS), glycated hemoglobin (HbA1c), lipid profile, glutathione, lipid peroxidation, superoxide, homocysteine (HCY), Na+/K±ATPase, and cardiac troponin were determined using standard laboratory methods. Compared with healthy controls, patients with T2DM and ACS exhibited significantly elevated FBS, HbA1c, total cholesterol (TC), triglycerides, low-density lipoprotein cholesterol (LDL-C), very-low-density lipoprotein cholesterol (VLDL-C), HCY, and lipid peroxidation, whereas high-density lipoprotein cholesterol (HDL-C), glutathione, and Na+/K±ATPase activity were significantly reduced (all P<0.001). Superoxide levels were also significantly decreased in patients compared with healthy controls (P<0.001). Correlation analysis demonstrated a significant positive correlation between cardiac troponin and Na+/K±ATPase activity (r=0.337, P=0.008), while no significant correlations were observed between FBS, HbA1c, lipid profile parameters, oxidative stress biomarkers, HCY, and the remaining investigated biomarkers. ROC analysis demonstrated excellent diagnostic performance for Na+/K±ATPase, glutathione, lipid peroxidation, superoxide, and HCY, with high sensitivity and specificity for discriminating patients from healthy controls. In conclusion, patients with T2DM complicated by ACS exhibit profound metabolic disturbances coupled with pronounced oxidative stress, hyperhomocysteinemia, altered Na+/K±ATPase activity, and myocardial damage, highlighting the utility of integrated biomarker profiling. https://acta.tums.ac.ir/index.php/acta/article/view/12342 https://acta.tums.ac.ir/index.php/acta/article/download/12342/6098