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|Objective||To evaluate associations between the levels of lipid subfractions (low-density lipoprotein [LDL] cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides and non-HDL cholesterol) and the incidence of diabetic retinopathy, peripheral neuropathy and nephropathy.|
|Study design||Observational cohort study based on data from the HealthCore Integrated Research Database (2004-2010).|
Multivariate Cox proportional hazards models were used to investigate the relative significance of lipid subfractions and achievement of lipid goals on the risk of diabetic microvascular complications. Univariate sensitivity analysis was used to investigate the independence of the association between the triglycerides/HDL and risk for microvascular complications.
TG triglycerides; RR relative risk
Goal-attainment of atherogenic dyslipidemia components beneficially may impact the risk for microvascular events among patients with type 2 diabetes.
Previous evidence has highlighted the relationship between atherogenic dyslipidemia, the combination of elevated triglycerides and low HDL cholesterol, with microvascular risk in type 2 diabetes.1-4 In a study by Zoppini et al (2012),2 previously highlighted by the R3i, the triglycerides-HDL cholesterol ratio was shown to be an important prognostic index of risk for microvascular disease, beyond blood glucose and blood pressure, in patients with type 2 diabetes. Individuals with a high triglycerides-HDL cholesterol ratio had about twice the risk of new-onset microvascular events compared with those with a lower ratio.
Adding to these findings, the current study shows that in a real-world managed care setting achieving recommended targets for triglycerides and HDL cholesterol has the potential to substantially impact the risk of diabetic microvascular complications. Even in patients with type 2 diabetes at LDL cholesterol goal, there was a further 24% reduction in risk of microvascular events. Indeed, the study showed no clear association between achievement of the recommended goal for LDL cholesterol and risk for diabetic microvascular events.
The study does have a number of limitations, including the possibility of miscoding of claims (and hence events), and limited duration of follow-up (<2 years). Despite these caveats, the data highlight the relevance of expanding lipid treatment goals beyond LDL cholesterol in this predominantly working-age patient population. Thus, effective management of atherogenic dyslipidemia, in addition to current standards of care for LDL cholesterol, blood pressure and glycaemia, has the potential to impact the substantial burden of residual microvascular risk in type 2 diabetes.
Given the escalating epidemic of type 2 diabetes, with more than 371 million currently affected world-wide,5 these data provide new support for targeting atherogenic dyslipidemia to reduce the high residual microvascular risk that persists in patients with type 2 diabetes.
1. Press release. New Insights Link Low HDL-Cholesterol and Elevated Triglycerides with Coronary Heart Disease and Microvascular Complications in Patients at Goal for LDL-Cholesterol. Available from http://www.r3i.org/press/pressreleases.asp