Association between low-density lipoprotein cholesterol and sudden cardiac arrest in people with diabetes mellitus

Abstract

Background Dyslipidemia measured as low-density lipoprotein (LDL)-cholesterol is an established risk factor of cardiovascular disease, which is more pronounced in diabetes population. Less is known about the association of LDL-cholesterol level and sudden cardiac arrest (SCA) risk in diabetes mellitus patients. This study investigated the association of LDL-cholesterol level and SCA risk in diabetes population. Methods This study was based on Korean National Health Insurance Service database. Patients who received general examination from 2009 to 2012 and diagnosed as type 2 diabetes mellitus were analyzed. Primary outcome was defined as SCA event identified with International Classification of Disease code. Results A total of 2,602,577 patients were included, with total follow-up duration of 17,851,797 person * year. Mean follow-up duration was 6.86 years, and 26,341 SCA cases were identified. Overall incidence of SCA was highest in the lowest LDL-cholesterol group (< 70 mg/dL) and decreased in a linear manner as LDL-cholesterol rises, till 160 mg/dL. Adjustment of covariates resulted in U-shape association, with highest risk of SCA in the highest LDL-cholesterol group (≥ 160 mg/dL) followed by lowest LDL-cholesterol group (< 70 mg/dL). In subgroup analysis, U-shape association between SCA risk and LDL-cholesterol was more pronounced in male, non-obese people, and those who did not use statins. Conclusions In people with diabetes, the association between SCA and LDL-cholesterol level was U-shaped with highest and lowest LDL-cholesterol group having higher risk of SCA than others. Low LDL-cholesterol level can be a surrogate marker for increased risk of SCA in people with diabetes mellitus and this paradoxical association should be recognized and extended to clinical preventive measures.

Risk of Cardiovascular Disease according to Baseline Low-Density Lipoprotein Cholesterol Level in Different Age Groups in Korean Diabetes Population: A Cohort Study

“…The chi-square test and Student's t-test were used to compare the means of the variables. Participants were classified into eight groups based on their baseline LDL-C levels, with intervals of 15 mg/dL, a convention previously employed in a similar study (<70, <85, <100, <115, <130, <145, <160, and ≥160 mg/dL) and five groups according to the age group (<40, 40-49, 50-59, 60-69, and ≥70 years) [18]. Cox proportional hazard modeling was conducted to calculate the risk of the primary outcome according to LDL-C levels.…”

Management of diabetes mellitus patients with sickle cell anemia: Challenges and therapeutic approaches

“…[22] Therefore, the interpretation of HbA1c levels in individuals with both DM and SCA requires caution. [23] Healthcare providers should consider alternative methods for assessing glycemic control in these individuals. Some alternatives include: Regular self-monitoring of blood glucose levels using a glucometer to track day-to-day variations in blood sugar levels.…”

The Ketogenic Diet and Cardiovascular Diseases

“…Low-density lipoprotein (LDL) is considered the so-called "bad cholesterol" and an even more significant risk factor than TC [27][28][29]. A 2023 publication showed that the effect of the LDL cholesterol concentration on the risk of sudden cardiac arrest (SCA) followed a "U" shape, i.e., the highest risk occurred at the lowest and highest LDL concentrations [30]. It further appears that the lowest and highest LDL concentrations are also associated with the overall risk of cardiovascular death.…”