Bleich David, Biggs Mary L, Gardin Julius M, Lyles Mary, Siscovick David S, Mukamal Kenneth J
Division of Endocrinology, Diabetes, & Metabolism, Rutgers New Jersey Medical School, 185 South Orange Avenue, MSB I-588, Newark, NJ 07103, United States.
University of Washington School of Medicine, Seattle, WA, United States.
Am J Prev Cardiol. 2024 Aug 26;19:100725. doi: 10.1016/j.ajpc.2024.100725. eCollection 2024 Sep.
To determine whether discrete lipid profiles (refer to as lipid phenotyping) can be used to stratify cardiovascular risk in individuals with type 2 diabetes.
Cardiovascular Health Study participants with diabetes and fasting lipid profiles at baseline ( = 866) were categorized separately by level of LDL cholesterol and HDL-C/Triglyceride (Tg) profiles (low Tg/high HDL-C; high Tg/low HDL-C; high Tg only or low HDL-C only). We performed Cox multivariate regression analysis to assess the risk of CVD mortality, incident myocardial infarction (MI), heart failure (HF), stroke, and composite MACE (MI, HF, stroke, and CVD mortality) associated with each lipid category. We also calculated risk estimates for MACE using lipid measures as continuous variables. In the fully adjusted model, the high triglyceride plus low HDL-C cholesterol phenotype demonstrated risk that was at least as high as the highest LDL-C sub-group phenotype for CVD mortality (Hazard ratio {HR} 1.58 vs 1.48), MI (HR 1.53 vs 1.58), HF (HR 1.47 vs 1.20), stroke (HR 2.02 vs 1.43), and MACE (HR 1.58 vs 1.38). When modeled continuously, the HR per SD for MACE was 1.12 ( = 0.03) for LDL-C and 1.19-1.20 ( < 0.001) for triglycerides or remnant cholesterol.
Participants with the high triglyceride/low HDL-C phenotype had equivalent or higher CVD risk than those with the high LDL-C phenotype. Further studies are necessary to determine whether lipid phenotyping accounts for the substantial CVD risk not explained by LDL cholesterol among individuals with type 2 diabetes.
确定离散血脂谱（称为血脂表型分析）是否可用于对2型糖尿病患者的心血管风险进行分层。
心血管健康研究中具有糖尿病且基线时有空腹血脂谱的参与者（n = 866），根据低密度脂蛋白胆固醇水平和高密度脂蛋白胆固醇/甘油三酯（Tg）谱进行分类（低Tg/高HDL-C；高Tg/低HDL-C；仅高Tg或仅低HDL-C）。我们进行了Cox多变量回归分析，以评估与每种血脂类别相关的心血管疾病死亡率、首次心肌梗死（MI）、心力衰竭（HF）、中风和复合主要不良心血管事件（MI、HF、中风和心血管疾病死亡率）的风险。我们还使用血脂测量值作为连续变量计算主要不良心血管事件的风险估计值。在完全调整模型中，高甘油三酯加低高密度脂蛋白胆固醇表型显示出的风险至少与最高低密度脂蛋白胆固醇亚组表型在心血管疾病死亡率（风险比{HR} 1.58对1.48）、MI（HR 1.53对1.58）、HF（HR 1.47对1.20）、中风（HR 2.02对1.43）和主要不良心血管事件（HR 1.58对1.38）方面的风险一样高。当进行连续建模时，对于主要不良心血管事件，每标准差的HR对于低密度脂蛋白胆固醇为1.12（P = 0.03），对于甘油三酯或残留胆固醇为1.19 - 1.20（P < 0.001）。
高甘油三酯/低高密度脂蛋白胆固醇表型的参与者与高高密度脂蛋白胆固醇表型的参与者相比，具有同等或更高的心血管疾病风险。有必要进行进一步研究，以确定血脂表型分析是否能解释2型糖尿病患者中未由低密度脂蛋白胆固醇解释的大量心血管疾病风险。
