Endocrinology Department, Centro Hospitalar e Universitário do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal.
Endocrinology Department, Hospital de Braga, Sete Fontes, São Victor, 4710-243, Braga, Portugal.
Lipids Health Dis. 2020 Jun 6;19(1):127. doi: 10.1186/s12944-020-01292-w.
Lipid-lowering therapy is guided by Low-density-lipoprotein cholesterol (LDL-c) levels, although the cardiovascular disease (CVD) risk could be better reflected by other lipid parameters. This study aimed at comparing a comprehensive lipid profile between patients with type 2 diabetes mellitus (T2DM) with LDL-c concentration within and above target.
A comprehensive lipid profile was characterized in 96 T2DM patients. The European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) 2016 and 2019 Guidelines for the Management of Dyslipidemias were used to define LDL-c targets.
In this population, only 28.1 and 16.7% of patients had mean LDL-c levels within target, as defined by the 2016 and 2019 guidelines, respectively. Applying the 2016 guidelines criteria, in patients with LDL-c within target, 22, 25 and 44% presented non-high-density lipoprotein cholesterol (non-HDL-c), Apolipoprotein B (ApoB) and oxidized LDL-c levels above the recommended range, respectively, whereas according to the 2019 guidelines criteria, 50, 39 and 44% of the patients with LDL-c within target had elevated high-density lipoprotein cholesterol (HDL-c), ApoB and oxidized LDL-c levels, respectively. LDL-c was strongly correlated with non-HDL-c (r = 0.850), ApoB (r = 0.656) and oxidized LDL-c (r = 0.508). Similarly, there was a strong correlation between non-HDL-c with both ApoB (r = 0.808) and oxidized LDL-c (r = 0.588).
These findings emphasize the limitations of only considering LDL-c concentration for cardiovascular (CV) risk assessment. Targeting only LDL-c could result in missed opportunities for CV risk reduction in T2DM patients. These data suggest that non-HDL-c, ApoB and oxidized LDL-c levels could be considered as an important part of these patients' evaluation allowing for a more accurate estimation of CV risk and hopefully better management of these high-risk patients.
降脂治疗以低密度脂蛋白胆固醇（LDL-c）水平为指导，但其他脂质参数可能更好地反映心血管疾病（CVD）风险。本研究旨在比较 2 型糖尿病（T2DM）患者的综合脂质谱与 LDL-c 浓度在目标值内和目标值以上的情况。
对 96 例 T2DM 患者的综合脂质谱进行了特征描述。采用欧洲心脏病学会/欧洲动脉粥样硬化学会（ESC/EAS）2016 年和 2019 年血脂异常管理指南来定义 LDL-c 目标值。
在该人群中，仅分别有 28.1%和 16.7%的患者的 LDL-c 平均水平符合 2016 年和 2019 年指南定义的目标值。根据 2016 年指南标准，在 LDL-c 水平达标的患者中，分别有 22%、25%和 44%的患者非高密度脂蛋白胆固醇（non-HDL-c）、载脂蛋白 B（ApoB）和氧化型 LDL-c 水平超过推荐范围，而根据 2019 年指南标准，分别有 50%、39%和 44%的 LDL-c 水平达标的患者的高密度脂蛋白胆固醇（HDL-c）、ApoB 和氧化型 LDL-c 水平升高。LDL-c 与 non-HDL-c（r=0.850）、ApoB（r=0.656）和氧化型 LDL-c（r=0.508）均呈强相关性。同样，non-HDL-c 与 ApoB（r=0.808）和氧化型 LDL-c（r=0.588）也呈强相关性。
这些发现强调了仅考虑 LDL-c 浓度评估心血管（CV）风险的局限性。仅针对 LDL-c 进行靶向治疗可能会导致 2 型糖尿病患者错失降低 CV 风险的机会。这些数据表明，non-HDL-c、ApoB 和氧化型 LDL-c 水平可作为这些患者评估的重要组成部分，从而更准确地估计 CV 风险，并有望更好地管理这些高危患者。
