Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China.
School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, China.
J Diabetes. 2022 Jun;14(6):365-376. doi: 10.1111/1753-0407.13273. Epub 2022 Jun 6.
Greater lipid variability may cause adverse health events among diabetic patients. We aimed to examine the effect of lipid variability on the risk of diabetic microvascular outcomes among type 2 diabetes mellitus patients.
We assessed the association between visit-to-visit variability (measured by variability independent of mean) in high-density lipoprotein (HDL) cholesterol, low-density lipoprotein-cholesterol (LDL), triglyceride, and remnant cholesterol (RC) measurements among participants involved in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study and the risk of incident microvascular outcomes, including nephropathy, neuropathy, and retinopathy. Cox proportional hazards models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs), adjusted for potential confounders.
There were 2400, 2470, and 2468 cases of nephropathy, neuropathy, and retinopathy during a follow-up period of 22 600, 21 542, and 26 701 person-years, respectively. Higher levels of HDL, triglyceride, and RC variability were associated with an increased risk of incident nephropathy and neuropathy. Compared with the lowest quartile, the fully adjusted HRs (95% CI) for the highest quartile of HDL, triglyceride, and RC variability for nephropathy risk were 1.57 (1.22, 2.01), 1.50 (1.18, 1.92), and 1.40 (1.09, 1.80), respectively; and for neuropathy, the corresponding risks were 1.36 (1.05, 1.75), 1.47 (1.14, 1.91), and 1.35 (1.04, 1.74), respectively. Null association was observed between LDL variability and all microvascular complications. Additionally, all associations of variability in the other lipids with retinopathy risk were null.
Among individuals with type 2 diabetes mellitus, HDL, triglyceride, and RC variability were associated with increased risks of nephropathy and neuropathy but not retinopathy.
ClinicalTrials.gov., no. NCT00000620.
血脂变异性增加可能导致糖尿病患者发生不良健康事件。本研究旨在探讨 2 型糖尿病患者血脂变异性与糖尿病微血管结局风险的关系。
我们评估了参与心血管风险行动控制糖尿病（ACCORD）研究的参与者的高密度脂蛋白胆固醇（HDL）、低密度脂蛋白胆固醇（LDL）、甘油三酯和残余胆固醇（RC）测量的随访间变异性（通过均值独立的变异性衡量）与微血管结局（包括肾病、神经病和视网膜病变）发生风险之间的关联。使用 Cox 比例风险模型估计风险比（HR）和 95%置信区间（CI），并进行了潜在混杂因素的调整。
在 22600、21542 和 26701 人年的随访期间，分别有 2400、2470 和 2468 例肾病、神经病和视网膜病变发生。较高的 HDL、甘油三酯和 RC 变异性水平与肾病和神经病的发病风险增加相关。与最低四分位相比，HDL、甘油三酯和 RC 变异性最高四分位的肾病风险的完全调整 HR（95%CI）分别为 1.57（1.22，2.01）、1.50（1.18，1.92）和 1.40（1.09，1.80）；神经病的相应风险分别为 1.36（1.05，1.75）、1.47（1.14，1.91）和 1.35（1.04，1.74）。LDL 变异性与所有微血管并发症之间呈零关联。此外，其他脂质变异性与视网膜病变风险之间的所有关联均为零。
在 2 型糖尿病患者中，HDL、甘油三酯和 RC 变异性与肾病和神经病风险的增加相关，但与视网膜病变风险无关。
ClinicalTrials.gov，编号 NCT00000620。
