Takenouchi Akiko, Tsuboi Ayaka, Kitaoka Kaori, Minato Satomi, Kurata Miki, Fukuo Keisuke, Kazumi Tsutomu
Department of Food Sciences and Nutrition, School of Human Environmental Sciences, Nishinomiya, Hyogo, Japan.
Research Institute for Nutrition Sciences, Mukogawa Women's University, Nishinomiya, Hyogo, Japan; Department of Nutrition, Osaka City Juso Hospital, Osaka, Japan.
J Clin Med Res. 2017 Apr;9(4):310-316. doi: 10.14740/jocmr2871w. Epub 2017 Feb 21.
Studies demonstrated that visit-to-visit variability in low-density lipoprotein cholesterol (LDLC) is an independent predictor of cardiovascular events in subjects with coronary artery disease. Whether visit-to-visit variability in LDLC levels affects subclinical atherosclerosis is unknown. This study sought to evaluate the role of visit-to-visit variability in LDLC levels on subclinical atherosclerosis.
We evaluated 162 type 2 diabetic patients with measurement of carotid intima-media thickness (IMT). Intrapersonal mean and standard deviation (SD) of six measurements of LDLC during 12 months were calculated. Multivariate linear regressions assessed the independent correlates of carotid IMT.
The mean and SD of LDLC were 112 ± 22 and 15 ± 10 mg/dL, respectively, and 43.2% of patients were on hypolipidemic drugs. Age (standardized β = 0.355, P < 0.001), male sex (standardized β = 0.234, P = 0.002) and SD-LDLC (standardized β = 0.201, P = 0.009) emerged as independent determinants of carotid maximum IMT independently of mean LDLC levels, body mass index (BMI), waist circumference, duration and treatment of diabetes, means and SDs of glycemic and other lipid variables, and uses of hypolipidemic and anti-hypertensive medications (R = 0.15). Results did not change when mean IMT was used instead of maximum IMT. After controlling for age and sex, maximum IMT was thicker in patients with the highest compared to those with other three quartiles of SD-LDLC combined (1.14 ± 0.04 (SE) vs. 1.01 ± 0.02 mm, P = 0.01). Independent determinants of SD-LDLC were mean LDLC, use of hypolipidemic drugs, fasting triglyceride and visit-to-visit variability in HbA1c.
Consistency of LDLC levels may be important to subclinical atherosclerosis in real-world patients with type 2 diabetes. It may be important for patients on lipid-lowering drugs to prevent non-compliance.
研究表明，冠心病患者低密度脂蛋白胆固醇（LDLC）的逐次就诊变异性是心血管事件的独立预测因素。LDLC水平的逐次就诊变异性是否会影响亚临床动脉粥样硬化尚不清楚。本研究旨在评估LDLC水平的逐次就诊变异性对亚临床动脉粥样硬化的作用。
我们评估了162例2型糖尿病患者的颈动脉内膜中层厚度（IMT）。计算了12个月内LDLC六次测量的个体内均值和标准差（SD）。多变量线性回归评估了颈动脉IMT的独立相关因素。
LDLC的均值和SD分别为112±22和15±10mg/dL，43.2%的患者正在服用降脂药物。年龄（标准化β=0.355，P<0.001）、男性（标准化β=0.234，P=0.002）和SD-LDLC（标准化β=0.201，P=0.009）是颈动脉最大IMT的独立决定因素，独立于平均LDLC水平、体重指数（BMI）、腰围、糖尿病病程和治疗、血糖及其他血脂变量的均值和SD，以及降脂和抗高血压药物的使用情况（R=0.15）。当使用平均IMT代替最大IMT时，结果未改变。在控制年龄和性别后，与SD-LDLC其他三个四分位数组合的患者相比，SD-LDLC最高四分位数的患者最大IMT更厚（1.14±0.04（SE）对1.01±0.02mm，P=0.01）。SD-LDLC的独立决定因素是平均LDLC、降脂药物的使用、空腹甘油三酯和HbA1c的逐次就诊变异性。
在现实世界的2型糖尿病患者中，LDLC水平的一致性对亚临床动脉粥样硬化可能很重要。对于服用降脂药物的患者，预防不依从可能很重要。
