Department of Medicine University of Maryland Medical Center Baltimore MD.
Division of Endocrinology, Diabetes & Metabolism Department of Medicine Johns Hopkins School of Medicine Baltimore MD.
J Am Heart Assoc. 2021 Apr 6;10(7):e016947. doi: 10.1161/JAHA.120.016947. Epub 2021 Mar 17.
Background Metabolic dyslipidemia (high triglyceride) and low high-density lipoprotein cholesterol (HDL-C) is highly prevalent in type 2 diabetes mellitus (T2DM). The extent to which diabetes mellitus-related abnormalities in the triglyceride-HDL-C profile associates with cardiovascular disease (CVD) risk is incompletely understood. We evaluated the associations of triglyceride and HDL-C status with CVD outcomes in individuals with T2DM. Methods and Results We analyzed data from 4199 overweight/obese adults with T2DM free of CVD with available data on triglyceride and HDL-C at baseline (2001-2004) in the Look AHEAD (Action for Health in Diabetes) study. We used Cox proportional models to estimate hazard ratios (HRs) and 95% CIs of: (1) composite CVD outcome (myocardial infarction, stroke, hospitalization for angina, and/or death from cardiovascular causes); (2) coronary artery disease events; and (3) cerebrovascular accidents (stroke). Of the 4199 participants, 62% (n=2600) were women, with a mean age of 58 years (SD, 7), and 40% (n=1659) had metabolic dyslipidemia at baseline. Over a median follow-up of 9.5 years (interquartile range, 8.7-10.3), 500 participants experienced the composite CVD outcome, 396 experienced coronary artery disease events, and 100 experienced stroke. Low HDL-C was associated with higher hazards of the composite CVD outcome (HR, 1.36; 95% CI, 1.12-1.64 [=0.002]) and coronary artery disease events (HR, 1.46; 95% CI, 1.18-1.81 [=0.001]) but not stroke (HR, 1.38; 95% CI, 0.90-2.11 [=0.140]). Compared with patients with normal triglyceride and normal HDL, participants with metabolic dyslipidemia had higher risks of the composite CVD outcome (HR, 1.30; 95% CI, 1.03-1.63 [=0.025]) and coronary artery disease events (HR, 1.48; 95% CI, 1.14-1.93 [=0.003]) but not stroke (HR, 1.23; 95% CI, 0.74-2.05 [=0.420]). Conclusions In a large sample of overweight/obese individuals with T2DM, metabolic dyslipidemia was associated with higher risks of CVD outcomes. Our findings highlight the necessity to account for metabolic dyslipidemia in CVD risk stratification among patients with T2DM. Registration URL: https://www.lookaheadtrial.org; Unique identifier: NCT00017953.
代谢性血脂异常（高甘油三酯）和低高密度脂蛋白胆固醇（HDL-C）在 2 型糖尿病（T2DM）中非常普遍。糖尿病相关的甘油三酯-高密度脂蛋白胆固醇谱异常与心血管疾病（CVD）风险之间的关联程度尚不完全清楚。我们评估了 T2DM 患者的甘油三酯和 HDL-C 状态与 CVD 结局之间的关系。
我们分析了来自 4199 名超重/肥胖的 T2DM 患者的数据，这些患者在 LOOK AHEAD（糖尿病中的健康行动）研究中基线时（2001-2004 年）有可用的甘油三酯和 HDL-C 数据，且无 CVD。我们使用 Cox 比例模型来估计：（1）复合 CVD 结局（心肌梗死、中风、心绞痛住院和/或心血管原因死亡）；（2）冠心病事件；和（3）脑血管意外（中风）的风险比（HR）和 95%CI。在 4199 名参与者中，62%（n=2600）为女性，平均年龄 58 岁（标准差，7），40%（n=1659）基线时存在代谢性血脂异常。在中位数为 9.5 年（四分位间距，8.7-10.3）的随访期间，500 名参与者发生了复合 CVD 结局，396 名发生了冠心病事件，100 名发生了中风。低 HDL-C 与复合 CVD 结局（HR，1.36；95%CI，1.12-1.64[=0.002]）和冠心病事件（HR，1.46；95%CI，1.18-1.81[=0.001]）的风险升高相关，但与中风（HR，1.38；95%CI，0.90-2.11[=0.140]）无关。与甘油三酯正常和 HDL 正常的患者相比，代谢性血脂异常患者的复合 CVD 结局（HR，1.30；95%CI，1.03-1.63[=0.025]）和冠心病事件（HR，1.48；95%CI，1.14-1.93[=0.003]）风险升高，但中风（HR，1.23；95%CI，0.74-2.05[=0.420]）风险无显著升高。
在一项大型超重/肥胖 T2DM 患者样本中，代谢性血脂异常与 CVD 结局风险升高相关。我们的研究结果强调了在 T2DM 患者的 CVD 风险分层中考虑代谢性血脂异常的必要性。
