Abstract: Objective To investigate the characteristics and determinants of electrocardiographic ST-T segment alterations in middle-aged and older adult populations diagnosed with dyslipidemia. Methods Individuals aged ≥45 years who were identified with dyslipidemia during routine community health examinations between January 2022 and December 2025 were enrolled in this study. Electrocardiography (ECG) was performed to ascertain the epidemiological characteristics of dyslipidemia and the incidence rate of ST-T alterations. A multivariate logistic regression model was employed to evaluate the influencing factors of ST-T changes, utilizing sex, age, body mass index (BMI), hypertension, diabetes mellitus, and dyslipidemia subtype as independent variables. Results Among the 1 200 screened individuals, the detection rate of dyslipidemia was 41.00% (492/1 200), which comprised 73 cases of isolated hypercholesterolemia, 88 cases of isolated hypertriglyceridemia, 208 cases of mixed hyperlipidemia, and 123 cases of low high-density lipoprotein cholesterol (HDL-C). Within the cohort of 492 patients with dyslipidemia, ST-T segment alterations were observed in 189 cases (38.41%). Multivariate logistic regression analysis revealed that female sex (OR=2.186), age ≥60 years (OR=2.906), BMI>24.0 kg/m² (OR=6.401), hypertension (OR=2.797), diabetes mellitus (OR=2.250), and mixed hyperlipidemia (OR=19.237) were independent risk factors for ST-T alterations (all P<0.05). Notably, the risk associated with mixed hyperlipidemia was the most pronounced, demonstrating an odds ratio significantly superior to those of low HDL-C, hypertriglyceridemia, and hypercholesterolemia. Conclusion The prevalence of dyslipidemia among community-dwelling middle-aged and older adults remains substantial, with mixed hyperlipidemia emerging as the predominant subtype. Female sex, advanced age, overweight, comorbid hypertension and/or diabetes mellitus, and mixed hyperlipidemia significantly elevate the susceptibility to electrocardiographic ST-T alterations. Clinical practice should prioritize the screening of these high-risk factors and the implementation of targeted interventions to mitigate the potential incidence of adverse cardiovascular events.

Key words: Dyslipidemia, Electrocardiogram, ST‑T changes, Middle‑aged and elderly, Clinical characteristics, Influencing factors