Division of Endocrinology and Metabolism, Department of Internal Medicine, China Medical University Hospital, Taichung 404, Taiwan.
Department of Neurology, Show Chwan Memorial Hospital, Changhua 500, Taiwan.
Nutrients. 2023 Jul 24;15(14):3270. doi: 10.3390/nu15143270.
Lipid-lowering drugs (LLDs) have protective effects against coronary artery disease (CAD) and cerebrovascular disease (CVD); however, a paradoxical association with cholesterol has been identified in several diseases, such as diabetes, dementia, and atrial fibrillation. We aimed to analyze the association between LLDs and cholesterol levels in older adults with type 2 diabetes mellitus (T2DM). This cross-sectional study enrolled consecutive patients aged ≥50 years from three centers in Taiwan. A multiple logistic regression model was used, and odds ratios (ORs) for different levels of total cholesterol (TC) or low-density-lipoprotein cholesterol (LDL-C) compared with the highest level were adjusted for age, triglyceride level, sex, comorbidities, and medications. Among the 3688 participants, 572 with and 676 without T2DM used LLDs. After adjusting for age and sex, the non-T2DM group demonstrated better medical conditions, cognition, and daily function than the T2DM group, regardless of LLD use. Compared to the highest TC level (≥240 mg/dL), ORs were significantly increased as TC levels decreased. A similar pattern of T2DM prevalence was observed in LDL-C levels. Older people with T2DM demonstrated low cognitive and daily functions. Significantly reduced TC and LDL levels were associated with a higher T2DM prevalence in older adults regardless of LLD use. T2DM was associated with impaired cognitive and daily functioning. A higher prevalence of T2DM in older people with low cholesterol levels raises doubt surrounding cognition and daily function being jeopardized when the "lower is better" strategy is applied for the secondary prevention of CAD or CVD.
降脂药物（LLD）对冠状动脉疾病（CAD）和脑血管疾病（CVD）有保护作用；然而，在一些疾病中，如糖尿病、痴呆和心房颤动，已经发现胆固醇与这些疾病之间存在矛盾的关联。我们旨在分析降脂药物与 2 型糖尿病（T2DM）老年患者胆固醇水平之间的关系。这项横断面研究纳入了来自台湾三个中心的连续≥50 岁的患者。使用多因素逻辑回归模型，调整年龄、甘油三酯水平、性别、合并症和药物等因素后，与最高水平相比，总胆固醇（TC）或低密度脂蛋白胆固醇（LDL-C）不同水平的比值比（OR）。在 3688 名参与者中，572 名患有 T2DM 且使用降脂药物，676 名患有 T2DM 且未使用降脂药物。调整年龄和性别后，无论是否使用降脂药物，非 T2DM 组的医疗条件、认知和日常功能均优于 T2DM 组。与最高 TC 水平（≥240mg/dL）相比，TC 水平降低时 OR 显著增加。LDL-C 水平也观察到类似的 T2DM 患病率模式。患有 T2DM 的老年人认知和日常功能较差。无论是否使用降脂药物，TC 和 LDL 水平降低与老年人群中 T2DM 患病率增加显著相关。T2DM 与认知和日常功能受损有关。在使用降脂药物的情况下，低胆固醇水平的老年人中 T2DM 患病率较高，这对认知和日常功能可能会受到损害提出了质疑，因为“越低越好”策略适用于 CAD 或 CVD 的二级预防。
