Greater variability in lipid measurements associated with cardiovascular disease and mortality: A 10‐year diabetes cohort study
Aim To examine the associations between variability in lipids and the risk of cardiovascular disease (CVD) and mortality in patients with type 2 diabetes based on low‐density lipoprotein‐cholesterol (LDL‐C), the total cholesterol (TC) to high‐density lipoprotein‐cholesterol (HDL‐C) ratio and triglyc...
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| Published in: | Diabetes, obesity & metabolism Vol. 22; no. 10; pp. 1777 - 1788 |
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| Main Authors: | , , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
Oxford, UK
Blackwell Publishing Ltd
01-10-2020
Wiley Subscription Services, Inc |
| Subjects: | |
| Online Access: | Get full text |
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| Summary: | Aim
To examine the associations between variability in lipids and the risk of cardiovascular disease (CVD) and mortality in patients with type 2 diabetes based on low‐density lipoprotein‐cholesterol (LDL‐C), the total cholesterol (TC) to high‐density lipoprotein‐cholesterol (HDL‐C) ratio and triglycerides (TG).
Materials and methods
A retrospective cohort study included 125 047 primary care patients with type 2 diabetes aged 45‐84 years without CVD during 2008‐2012. The variability of LDL‐C, TC to HDL‐C and TG was determined using the standard deviation of variables in a mixed effects model to minimize regression dilution bias. The associations between variability in lipids and CVD and mortality risk were assessed by Cox regression. Subgroup analyses based on patients’ baseline characteristics were also conducted.
Results
A total of 19 913 CVD events and 15 329 mortalities were recorded after a median follow‐up period of 77.5 months (0.8 million person‐years), suggesting a positive linear relationship between variability in lipids and the risk of CVD and mortality. Each unit increase in the variability of LDL‐C (mmol/L), the TC to HDL‐C ratio and TG (mmol/L) was associated with a 27% (HR: 1.27 [95% CI: 1.20‐1.34]), 31% (HR:1.31 [95% CI: 1.25‐1.38]) and 9% (HR: 1.09 [95% CI: 1.04‐1.15]) increase in the risk of composite endpoint of CVD and mortality, respectively. Age‐specific effects were also found when comparing LDL‐C variability, with patients aged 45‐54 years (HR: 1.70 [95% CI: 1.42‐2.02]) exhibiting a 53% increased risk for the composite endpoints than those aged 75‐84 years (HR: 1.11 [95% CI: 1.01‐1.23]). Similar age effects were observed for both the TC to HDL‐C ratio and TG variability. Significant associations remained consistent among most of the subgroups.
Conclusions
Variability in respective lipids are significant factors in predicting CVD and mortality in primary care patients with type 2 diabetes, with the strongest effects related to LDL‐C and the TC to HDL‐C ratio and most significant in the younger age group of patients aged 45‐54 years. Further study is warranted to confirm these findings. |
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| Bibliography: | Funding information https://publons.com/publon/10.1111/dom.14093 Peer Review This study was funded by The Health Services Research Fund, Food and Health Bureau, HKSAR (ref. no. 14151181). The peer review history for this article is available at . ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Funding information This study was funded by The Health Services Research Fund, Food and Health Bureau, HKSAR (ref. no. 14151181). Peer Review The peer review history for this article is available at https://publons.com/publon/10.1111/dom.14093. |
| ISSN: | 1462-8902 1463-1326 |
| DOI: | 10.1111/dom.14093 |