Cholesterol levels and development of cardiovascular disease in Koreans with type 2 diabetes mellitus and without pre-existing cardiovascular disease - PubMed (original) (raw)
Cholesterol levels and development of cardiovascular disease in Koreans with type 2 diabetes mellitus and without pre-existing cardiovascular disease
Mee Kyoung Kim et al. Cardiovasc Diabetol. 2019.
Abstract
Background: The aim of the present study was to identify a threshold for the cholesterol level at which the risk of cardiovascular disease (CVD) begins to increase in people with type 2 diabetes mellitus (DM).
Methods: Using the Korean National Health Insurance Service database, 2,077,135 people aged ≥ 40 years with type 2 DM who underwent regular health checks between 2009 and 2012 were included. Subjects with previous CVD were excluded. Cox regression analyses were performed to estimate the risk of CVD for each low-density lipoprotein cholesterol (LDL-C) group using the < 70 mg/dL as the reference group.
Results: There were 78,560 cases of stroke (3.91%), and 50,791 myocardial infarction (MI, 2.53%) during a median follow-up of 7.1 years. Among participants not taking statins, LDL-C levels of 130-159 mg/dL and ≥ 160 mg/dL were significantly associated with the risk of MI: the hazard ratios (HRs) (95% confidence interval) were 1.19 (1.14-1.25) and 1.53 (1.46-1.62), respectively. Among participants taking statins, all categories of LDL-C level ≥ 70 mg/dL were significantly associated with increased risk of stroke and MI.
Conclusions: We identified an increased risk of CVD in people with an LDL-C level ≥ 130 mg/dL among individuals with type 2 DM not taking statins. The risk of CVD was significantly higher in those taking statins with an LDL-C level ≥ 70 mg/dL.
Keywords: Cardiovascular disease; Cholesterol; Diabetes mellitus; Dyslipidemia; Korea.
Conflict of interest statement
The authors declare that they have no competing interests.
Figures
Fig. 1
Sensitivity analyses of association between the LDL-C and myocardial infarction, and stroke stratified by statin non-user (a) and statin user (b); The LDL < 55 mg/dL group was taken as the reference category for the model. Participants were divided into the following categories of LDL-C levels: < 55 mg/dL (reference), 55 to 69 mg/dL, 70 to 99 mg/dL, 100 to 129 mg/dL, 130 to 159 mg/dL, and ≥ 160 mg/dL. Hazard ratios and 95% confidence intervals of myocardial infarction, and stroke according to the low-density lipoprotein cholesterol levels. Adjusted for age, sex, body mass index, alcohol drinking, smoking, regular exercise, income status, fasting glucose levels, hypertension, and duration of diabetes
References
- Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, Braun LT, de Ferranti S, Faiella-Tommasino J, Forman DE, Goldberg R, Heidenreich PA, Hlatky MA, Jones DW, Lloyd-Jones D, Lopez-Pajares N, Ndumele CE, Orringer CE, Peralta CA, Saseen JJ, Smith SC Jr, Sperling L, Virani SS, Yeboah J. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol. Circulation. 2018. (Epub ahead of print).
- Jellinger PS, Handelsman Y, Rosenblit PD, Bloomgarden ZT, Fonseca VA, Garber AJ, Grunberger G, Guerin CK, Bell DSH, Mechanick JI, Pessah-Pollack R, Wyne K, Smith D, Brinton EA, Fazio S, Davidson M. American Association of Clinical Endocrinologists and American College of Endocrinology guidelines for the management of dyslipidemia and prevention of cardiovascular disease. Endocr Pract. 2017;23:1–87. doi: 10.4158/EP171764.APPGL. - DOI - PubMed
- Rana JS, Liu JY, Moffet HH, Boklage SH, Khan I, Karter AJ. Risk of incident atherosclerotic cardiovascular disease events by achieved atherogenic lipid levels among 62,428 Statin-treated individuals with diabetes mellitus. Am J Cardiol. 2018;122:762–767. doi: 10.1016/j.amjcard.2018.05.011. - DOI - PubMed
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