From the, Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden.
Sachs' Children and Youth Hospital, Stockholm, Sweden.
J Intern Med. 2021 Jun;289(6):873-886. doi: 10.1111/joim.13212. Epub 2020 Dec 27.
Microvascular complications are common in people with diabetes, where poor glycaemic control is the major contributor. The aim of this study was to explore the association between elevated LDL cholesterol levels and the risk of retinopathy or nephropathy in young individuals with type 1 diabetes.
This was a nationwide observational population-based cohort study, including all children and adults with a duration of type 1 diabetes of ≤ 10 years, identified in the Swedish National Diabetes Register between 1998 and 2017. We calculated the crude incidence rates with 95% confidence intervals (CIs) and used multivariable Cox regression to estimate crude and adjusted hazard ratios (HRs) of retinopathy or nephropathy in four LDL cholesterol categories: <2.6 (Reference), 2.6-3.4, 3.4-4.1 and > 4.1 mmol L .
In total, 11 024/12 350 (retinopathy/nephropathy, both cohorts, respectively) children and adults (median age 21 years, female 42%) were followed up to 28 years from diagnosis until end of study. Median duration of diabetes when entering the study was 6 and 7 years in the retinopathy and nephropathy cohort, respectively. Median LDL cholesterol was 2.4 mmol L , and median HbA1c level was 61 mmol mol (7.7 %). After multivariable adjustment, the HRs (95% CI) for retinopathy in individuals with LDL cholesterol levels of 2.6-3.4, 3.4-4.1 or > 4.1 mmol L were as follows: 1.13 (1.03-1.23), 1.16 (1.02-1.32) and 1.18 (0.99-1.41), compared with the reference. The corresponding numbers for nephropathy were as follows: 1.15 (0.96-1.32), 1.30 (1.03-1.65) and 1.41 (1.06-1.89).
Young individuals with type 1 diabetes exposed to high LDL cholesterol levels have an increased risk of retinopathy and nephropathy independent of glycaemia and other identified risk factors for vascular complications.
微血管并发症在糖尿病患者中很常见，而血糖控制不佳是主要原因。本研究旨在探讨 LDL 胆固醇水平升高与 1 型糖尿病患者发生视网膜病变或肾病的风险之间的关系。
这是一项全国性的观察性基于人群的队列研究，纳入了 1998 年至 2017 年间在瑞典国家糖尿病登记处登记的 10 年以下病程的所有儿童和成人 1 型糖尿病患者。我们计算了四个 LDL 胆固醇类别（<2.6（参考）、2.6-3.4、3.4-4.1 和>4.1mmol/L）的粗发病率和 95%置信区间（CI），并使用多变量 Cox 回归估计视网膜病变或肾病的粗和调整后的危险比（HR）。
总共纳入了 11024/12350（视网膜病变/肾病，两个队列）儿童和成人（中位年龄 21 岁，女性 42%），从诊断开始随访 28 年，直至研究结束。进入研究时的糖尿病中位病程分别为视网膜病变和肾病队列的 6 年和 7 年。中位 LDL 胆固醇为 2.4mmol/L，中位糖化血红蛋白水平为 61mmol/mol（7.7%）。经多变量调整后，LDL 胆固醇水平为 2.6-3.4、3.4-4.1 或>4.1mmol/L 的个体发生视网膜病变的 HR（95%CI）分别为：1.13（1.03-1.23）、1.16（1.02-1.32）和 1.18（0.99-1.41），与参考值相比。肾病的相应数值分别为：1.15（0.96-1.32）、1.30（1.03-1.65）和 1.41（1.06-1.89）。
暴露于高 LDL 胆固醇水平的 1 型糖尿病年轻患者发生视网膜病变和肾病的风险增加，这与血糖和其他血管并发症的已知危险因素无关。
