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Lipid variables predicted CAD in some patients with type 1 diabetes
The capability of lipid variables to predict coronary artery disease events in patients with type 1 diabetes differs depending on sex, renal status and glycemic control, with current guidelines falling short of accuracy, according to research published in Diabetes Care.
Ratios of atherogenic and antiatherogenic lipoproteins and lipids were strong predictors of incident CAD in patients with normoalbuminuria, but not beneficial in macroalbuminuria, suggesting a potential revision in treatment recommendations.
In a study of participants from the Finnish Diabetic Nephropathy (FinnDiane) study, Nina Tolonen, MD, of the Folkhälsan Institute of Genetics, Folkhälsan Research Center, University of Helsinki, and colleagues looked at 3,520 patients with type 1 diabetes with available lipid profiles.
During the follow-up period, an average of 10.2 years, 310 patients (9%; 174 males, 137 females) experienced incident CAD. These patients had a lipid profile characterized by higher cholesterol (total, non-HDL and LDL), triglycerides and apolipoprotein B and lower HDL and HDL2 cholesterol vs. patients without CAD.
ApoB:ApoA-I ratio most strongly predicted CAD in patients with normoalbuminuria (HR=1.43; 95% CI, 1.17-1.76); ApoB was the strongest predictor in macroalbuminuria (HR=1.47; 95% CI, 1.19-1.81). Results remained similar when patients were stratified by sex or glycemic control.
LDL cholesterol proved to be a poor predictor of CAD in women, patients with HbA1c <8.3% (67 mmol/L) and patients with normoalbuminuria.
The 1.7 mmol/L triglyceride cutoff level currently recommended failed to predict CAD in patients with normoalbuminuria; however, the cohort median 0.94 mmol/L was able to predict incident CAD.
“Current treatment recommendations may need to be revised to capture residual CAD risk in patients with type 1 diabetes,” the researchers wrote.
Disclosure: The study was supported by the Folkhälsan Research Foundation, Wilhelm and Else Stockmann Foundation, Finnish Medical Society, Finnish Kidney Foundation, Biomedicum Helsinki Foundation, Dorothea Olivia, Karl Walter, and Jarl Walter Perklen Foundation, Novo Nordisk Foundation, Liv och Häslsa Foundation, Sigrid Juselius Foundation, Waldemar von Frenckell Foundation and American Heart Association. Some of the researchers report serving as consultants or board members for pharmaceutical companies or receiving grants or lecture fees.