CGH Medical Center, 101 east Miller Rd,, Sterling, IL, 61081, USA.
Cardiovasc Diabetol. 2012 Sep 14;11:109. doi: 10.1186/1475-2840-11-109.
Few large-scale, real-world studies have assessed the relative associations of lipid fractions with diabetic microvascular events. The main objective of this study was to evaluate the association of the lipid profile components, high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), triglycerides (TG), and non-high density lipoprotein cholesterol (non-HDL-C) with microvascular complications (MVCs) in type 2 diabetes mellitus (T2DM) patients.
This observational cohort study queried the HealthCore Integrated Research Database (HIRDSM) for newly-diagnosed (Index Date) 18-64-year-old patients with diabetes mellitus between 01/01/2005-06/30/2010. Inclusion required ≥ 12 months pre-index continuous health plan eligibility and ≥ 1 pre-index lipid profile result. Patients with polycystic ovary syndrome and prior MVCs were excluded. Incident complications were defined as the earliest occurrence of diabetic retinopathy, peripheral neuropathy, and/or nephropathy post-index. Cox proportional models and Kaplan-Meier (KM) curves were used to evaluate associations among variables.
Of the patients (N=72,267), 50.05% achieved HDL-C, 64.28% LDL-C, 59.82% TG, and 56.79% non-HDL-C American Diabetes Association goals at baseline. During follow-up (mean, 21.74 months), there were 5.21 microvascular events per 1,000 patient-months. A 1-mg/dL increase in HDL-C was associated with 1% decrease in any MVC risk (P< .0001), but for LDL-C, TG, and non-HDL-C, 1-mg/dL increase resulted in increases of 0.2% (P< .0001), 0.1% (P<0.001) and 0.3% (P<0.001) in MVC risk. Patients achieving HDL-C goals had a 11% lower risk of MVC versus non-achievers (RR 0.895, [95% CI, 0.852-0.941], P< .0001). Similarly, TG goal attainment was associated with a lowered risk for any MVC (RR 0.849, [95% CI, 0.808-0.892], P< .0001). Evaluation of KM survival curves demonstrated no significant difference in the risk of MVCs between patients achieving vs. not achieving LDL-C goals, but did demonstrate a difference in MVC risk between patients achieving vs. not achieving non-HDL-C goals.
This study demonstrates significant independent associations among lipid fractions and risk for microangiopathy. These findings suggest that attaining established ADA goals for HDL-C, TG, and non-HDL-C may reduce risk for microvascular events among patients with diabetes.
很少有大规模的真实世界研究评估脂质成分与糖尿病微血管事件的相对关联。本研究的主要目的是评估血脂成分高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、甘油三酯（TG）和非高密度脂蛋白胆固醇（non-HDL-C）与 2 型糖尿病（T2DM）患者微血管并发症（MVCs）的相关性。
本观察性队列研究在 HealthCore 综合研究数据库（HIRDSM）中查询了 2005 年 1 月 1 日至 2010 年 6 月 30 日期间年龄在 18-64 岁之间的新诊断（索引日期）的 18-64 岁糖尿病患者。纳入标准为索引前至少 12 个月持续参加健康计划和至少 1 次索引前血脂检查结果。排除多囊卵巢综合征和既往 MVCs 的患者。首发并发症定义为索引后最早出现的糖尿病视网膜病变、周围神经病变和/或肾病。Cox 比例模型和 Kaplan-Meier（KM）曲线用于评估变量之间的关联。
在患者中（N=72267），50.05%的患者在基线时达到了美国糖尿病协会的 HDL-C 目标，64.28%的患者达到了 LDL-C 目标，59.82%的患者达到了 TG 目标，56.79%的患者达到了非-HDL-C 目标。在随访期间（平均 21.74 个月），每 1000 个患者月发生 5.21 例微血管事件。HDL-C 增加 1mg/dL 与任何 MVC 风险降低 1%相关（P< .0001），但 LDL-C、TG 和非-HDL-C 增加 1mg/dL 分别导致 MVC 风险增加 0.2%（P< .0001）、0.1%（P<0.001）和 0.3%（P<0.001）。达到 HDL-C 目标的患者发生 MVC 的风险比未达到目标的患者低 11%（RR 0.895，[95%CI，0.852-0.941]，P< .0001）。同样，TG 目标的实现与任何 MVC 的风险降低相关（RR 0.849，[95%CI，0.808-0.892]，P< .0001）。KM 生存曲线的评估表明，达到 LDL-C 目标的患者与未达到 LDL-C 目标的患者之间 MVC 风险无显著差异，但达到非-HDL-C 目标的患者与未达到非-HDL-C 目标的患者之间 MVC 风险存在差异。
本研究表明脂质成分与微血管病变风险之间存在显著的独立关联。这些发现表明，在糖尿病患者中，达到美国糖尿病协会制定的 HDL-C、TG 和非-HDL-C 目标可能会降低微血管事件的风险。
