Department of Medicine, MetroWest Medical Center, Framingham, MA, USA.
Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea.
Diabetes Metab J. 2024 Mar;48(2):265-278. doi: 10.4093/dmj.2022.0443. Epub 2024 Feb 26.
The association between low-density lipoprotein (LDL-C) levels and cardiovascular disease (CVD) risk in different age groups within the diabetes mellitus (DM) population remains unclear. The cohort study was conducted to investigate this relationship.
We assessed the 2009 to 2012 Korean National Health Screening and National Health Insurance Service records, with follow-up to the primary outcome (myocardial infarction [MI] or stroke) or December 2018. After excluding the participants with a history of MI or stroke, 2,227,394 participants with DM were included and categorized according to baseline LDL-C levels and age. Cox proportional hazards modeling was conducted. The CVD risk of age <40 years and LDL-C <70 mg/dL was set as the reference. In each age group, LDL-C <70 mg/dL was used as a reference for the subgroup analysis.
The cut-off LDL-C value for increased MI risk in each age group varied (<40 years old, LDL-C ≥160 mg/dL: hazard ratios [HR], 2.03; 95% confidence interval [CI], 1.644 to 2.506) (40-49-year-old, LDL-C <115 mg/dL: HR, 1.245; 95% CI, 1.04 to 1.489) (50-59-year-old, LDL-C <115 mg/dL: HR, 1.21; 95% CI, 1.014 to 1.445) (60-69-year-old, LDL-C <145 mg/dL: HR, 1.229; 95% CI, 1.022 to 1.479) (≥70 years old group, LDL-C <100 mg/dL: HR, 1.238; 95% CI, 1.018 to 1.504). The cut-off LDL-C values for increased stroke risk varied in each age subgroup (<40 years old, LDL-C ≥160 mg/dL: HR, 1.395; 95% CI, 1.094 to 1.779) (40-49-year-old, LDL-C <145 mg/dL: HR, 1.13; 95% CI, 1.019 to 1.253) (50-59-year-old, LDL-C <160 mg/dL: HR, 1.079; 95% CI, 1.008 to 1.154) (60-69-year-old, LDL-C <130 mg/dL: HR, 1.07; 95% CI, 1.022 to 1.119) (≥70 years old, LDL-C <115 mg/dL: HR, 1.064; 95% CI, 1.019 to 1.112).
The effect of LDL-C on the risk of CVD differs depending on the age of the population with DM.
糖尿病（DM）患者中不同年龄组的低密度脂蛋白胆固醇（LDL-C）水平与心血管疾病（CVD）风险之间的关系尚不清楚。本队列研究旨在探讨这种关系。
我们评估了 2009 年至 2012 年韩国国家健康筛查和国家健康保险服务记录，并随访主要结局（心肌梗死[MI]或中风）或 2018 年 12 月。排除有 MI 或中风病史的参与者后，纳入 2227394 名 DM 患者，并根据基线 LDL-C 水平和年龄进行分类。采用 Cox 比例风险模型进行分析。年龄<40 岁且 LDL-C<70mg/dL 的 CVD 风险设为参照。在每个年龄组中，将 LDL-C<70mg/dL 作为亚组分析的参照。
每个年龄组中 MI 风险增加的 LDL-C 截断值不同（<40 岁，LDL-C≥160mg/dL：危险比[HR]，2.03；95%置信区间[CI]，1.644 至 2.506）（40-49 岁，LDL-C<115mg/dL：HR，1.245；95%CI，1.04 至 1.489）（50-59 岁，LDL-C<115mg/dL：HR，1.21；95%CI，1.014 至 1.445）（60-69 岁，LDL-C<145mg/dL：HR，1.229；95%CI，1.022 至 1.479）（≥70 岁组，LDL-C<100mg/dL：HR，1.238；95%CI，1.018 至 1.504）。中风风险增加的 LDL-C 截断值在每个年龄亚组中均有所不同（<40 岁，LDL-C≥160mg/dL：HR，1.395；95%CI，1.094 至 1.779）（40-49 岁，LDL-C<145mg/dL：HR，1.13；95%CI，1.019 至 1.253）（50-59 岁，LDL-C<160mg/dL：HR，1.079；95%CI，1.008 至 1.154）（60-69 岁，LDL-C<130mg/dL：HR，1.07；95%CI，1.022 至 1.119）（≥70 岁，LDL-C<115mg/dL：HR，1.064；95%CI，1.019 至 1.112）。
LDL-C 对 DM 患者 CVD 风险的影响因年龄而异。
