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LDL was not a reliable marker for CVD in type 1 diabetes
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SAN FRANCISCO — Low-density lipoprotein was not a significant predictor for cardiovascular disease in type 1 diabetes compared with high-density lipoprotein, according to research presented here at the American Diabetes Association’s 74th Scientific Sessions.
“As we all know, patients with diabetes have a higher risk for CVD. High LDL cholesterol has been considered an important risk factor in the general population and in patients with type 2 diabetes,” Christel Hero, MD, of Sahlgrenska University Hospital in Gothenburg, Sweden, said during a presentation here.
Hero and colleagues sought to examine the LDL-cholesterol and total-cholesterol-to-HDL ratio (chol/HDL) as a predictor for CVD among 30,778 patients (aged 18 to 79 years) with type 1 diabetes, with a mean disease duration of 20 years; HbA1c, 8%; LDL, 2.7 mmol/L; and HDL, 3.2 mmol/L. Ten percent of patients had a history of CVD, according to data.
Only 26.5% of patients (n=8,172) were treated with lipid-lowering medications; they tended to be older, with a longer disease duration and 24% had previous CVD.
The group who did not take lipid-lowering medications had 14.6 CVD events per 1,000 person-years, whereas the group who did take lipid-lowering medications tallied 52.3 events per 1,000 person-years, according to data.
For each 1 mmol/L increase in LDL, the researchers calculated adjusted hazard ratios (HRs) for CVD: 1.03 (95% CI, 0.99-1.08) in all patients; 1.08 (95%CI, 1.01-1.11) in patients without treatment; and 1.02 (95%CI, 0.96-1.08) among those with lipid-lowering medications.
More significantly, adjusted HRs per unit increase in chol/HDL for CVD were 1.08 (95% CI, 1.04-1.12) in all patients; 1.08 (95%CI, 1.03-1.14) among patients without treatment (P<.01); 1.06 (95%CI, 1.01-1.11) in those with lipid-lowering medications (P<.02).
Those without lipid-lowering medications in the highest LDL range (>3.6 mmol/L) demonstrated significantly greater risk for CVD (HR=1.24; 95% CI, 1.01-1.51), according to data.
Additionally, Hero presented the HRs for LDL and chol/HDL when divided into octiles.
“This is when it gets really interesting since there is no significance for LDL at all for predicting cardiovascular disease, while there on the other hand, is a strong significance for the ratio, especially for the non-treated patients and with a linearity (the higher the ratio the stronger the significance),” Hero told Endocrine Today.
“In our study, LDL was not the best predictor of CVD in type 1 diabetes. However, the ratio of HDL is a significant predictor CVD in patients without lipid-lowering medication,” Hero said. “The ratio of HDL cholesterol seems to be a more reliable marker for risk when considering primary prevention for diabetes.” – by Samantha Costa
Disclosure: Hero reports no relevant financial disclosures.
For more information: Hero C. Abstract 381-OR. Presented at: American Diabetes Association’s 74th Scientific Sessions; June 13-17, 2014; San Francisco.
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Robert H. Eckel, MD
Trevor Orchard, MD, professor of epidemiology, medicine and pediatrics at the University of Pittsburgh Graduate School of Public Health, recently raised the question and we reiterated what he said, which is that atherosclerosis in type 1 diabetes may be a whole other process. The fact that LDL is not a tremendous predictor in the cohort is not very surprising. The other thing about the ratio is that HDL cholesterol levels have reportedly been occurring higher in patients with type 1 diabetes, and if you looked at the data, the HDLs were quite high. They were using a denominator that may include HDL and may not be as functional. I think this is was an outstanding study supporting the concept that atherosclerosis in type 1 diabetes may not be the same animal. It may be more fibrotic, it may be more calcified, and it may not be identical to what we think about in patients with type 2 diabetes. I congratulate them on an outstanding study trying to provide more evidence that we need to study type 1 diabetes in more detail.
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