Department of Cardiology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, 3-1 Aoyamacho, Kure, Hiroshima 737-0023, Japan.
Diabetol Metab Syndr. 2013 Dec 6;5(1):77. doi: 10.1186/1758-5996-5-77.
A residual risk of cardiovascular disease tends to persist despite standard prevention therapy with statins. This may stem partly from increased oxidized low-density lipoprotein (LDL) levels. However, how oxidized LDL can be further reduced beyond statin therapy in high-risk diabetes patients remains unclear. We aimed to clarify the clinical factors associated with oxidized LDL levels in statin-treated high-risk diabetes patients.
This cross-sectional observational study included 210 diabetes patients with coronary artery diseases (CAD) who were treated with statins. We determined serum malondialdehyde-modified LDL (MDA-LDL), LDL cholesterol, high-density lipoprotein (HDL) cholesterol, triglyceride (TG), remnant lipoprotein cholesterol, hemoglobin (Hb) A1c, adiponectin, and C-reactive protein (CRP) levels and investigated the factors influencing the MDA-LDL level.
In univariate analysis, the MDA-LDL level was significantly correlated with LDL cholesterol (p < 0.0001), TG (p < 0.0001), HDL cholesterol (p = 0.017), and adiponectin (p = 0.001) levels but not with age, body mass index, waist circumference, blood pressure, or HbA1c levels. Even after adjusting for the LDL cholesterol level, the correlations between the MDA-LDL level and the TG, HDL cholesterol, and adiponectin levels were still significant. Among these significant factors, multivariate analysis revealed that the MDA-LDL level was independently associated with the LDL cholesterol, TG, and HDL cholesterol but not with adiponectin levels. The MDA-LDL level was also significantly associated with the CRP level (p = 0.014) and the remnant lipoprotein cholesterol level (p < 0.0001) independently of the LDL cholesterol level. The number of metabolic syndrome (MS) components was significantly associated with the MDA-LDL/LDL cholesterol ratio (p < 0.0001). Furthermore, the use of metformin and α-glucosidase inhibitors was inversely associated with high MDA-LDL levels (p = 0.033 and 0.018, respectively).
In statin-treated diabetes patients with CAD, the MDA-LDL level was significantly correlated with TG and HDL cholesterol levels. Adiponectin level was also significantly associated with the MDA-LDL level, but not independent of the above-mentioned factors. The management of dyslipidemic MS components, including the use of metformin or α-glucosidase inhibitors, may be important for reducing the oxidized LDL levels beyond statin therapy in high-risk diabetes patients.
尽管使用他汀类药物进行标准预防治疗，心血管疾病的残余风险仍倾向于持续存在。这可能部分源于氧化型低密度脂蛋白（LDL）水平升高。然而，在高危糖尿病患者中，除了他汀类药物治疗之外，如何进一步降低氧化型 LDL 水平仍不清楚。我们旨在阐明与他汀类药物治疗的高危糖尿病患者的氧化型 LDL 水平相关的临床因素。
这是一项横断面观察性研究，纳入了 210 名患有冠状动脉疾病（CAD）的糖尿病患者，这些患者正在接受他汀类药物治疗。我们测定了血清丙二醛修饰的 LDL（MDA-LDL）、LDL 胆固醇、高密度脂蛋白（HDL）胆固醇、甘油三酯（TG）、残粒脂蛋白胆固醇、血红蛋白（Hb）A1c、脂联素和 C 反应蛋白（CRP）水平，并探讨了影响 MDA-LDL 水平的因素。
在单因素分析中，MDA-LDL 水平与 LDL 胆固醇（p<0.0001）、TG（p<0.0001）、HDL 胆固醇（p=0.017）和脂联素（p=0.001）水平显著相关，但与年龄、体重指数、腰围、血压或 HbA1c 水平无关。即使在校正 LDL 胆固醇水平后，MDA-LDL 水平与 TG、HDL 胆固醇和脂联素水平之间的相关性仍然显著。在这些显著因素中，多因素分析显示 MDA-LDL 水平与 LDL 胆固醇、TG 和 HDL 胆固醇独立相关，但与脂联素水平无关。MDA-LDL 水平还与 CRP 水平（p=0.014）和残粒脂蛋白胆固醇水平（p<0.0001）独立于 LDL 胆固醇水平显著相关。代谢综合征（MS）成分的数量与 MDA-LDL/LDL 胆固醇比值显著相关（p<0.0001）。此外，使用二甲双胍和α-葡萄糖苷酶抑制剂与高 MDA-LDL 水平呈负相关（p=0.033 和 0.018）。
在接受他汀类药物治疗的 CAD 合并糖尿病患者中，MDA-LDL 水平与 TG 和 HDL 胆固醇水平显著相关。脂联素水平也与 MDA-LDL 水平显著相关，但不受上述因素的影响。管理血脂异常的 MS 成分，包括使用二甲双胍或α-葡萄糖苷酶抑制剂，可能对降低高危糖尿病患者除他汀类药物治疗之外的氧化型 LDL 水平很重要。
