Cholesterol remnants and triglycerides are associated with decreased myocardial function in patients with type 2 diabetes

Abstract

BackgroundRecently, genetic studies have suggested a causal relationship between cholesterol remnants and ischemic heart disease. We aimed to determine whether cholesterol remnants and its marker, triglyceride levels, are associated with cardiac function as determined by sensitive echocardiographic measures in a population of patients with type 2 diabetes.MethodsComprehensive echocardiography including 2D-speckle tracking echocardiography was performed on a representative sample of 924 patients with type 2 diabetes—730 of whom were treated with statins. These were recruited from two large secondary care centers.ResultsIn multivariable analyses, triglycerides and cholesterol remnants were not associated with left ventricular ejection fraction, but with subtle measures of systolic function, including global longitudinal strain by speckle tracking and longitudinal displacement by tissue Doppler echocardiography: global longitudinal strain [0.33 % (0.14), p = 0.02 per doubling in cholesterol remnants and 0.28 % (0.13), p = 0.03 per doubling in triglyceride levels] and with longitudinal displacement [−0.25 mm (0.10), p = 0.01 per doubling in cholesterol remnants and −0.25 mm (0.09), p = 0.005 per doubling in triglyceride levels]. Subgroup analyses of patients receiving statin therapy and patients without known heart disease revealed similar results, but the association was not present in patients with known heart disease.ConclusionIn patients with type 2 diabetes, subtle decrease in left ventricular function is present with increasing levels of cholesterol remnants and triglyceride levels indicating an effect of these on cardiac function that is not detectable by conventional echocardiography.Electronic supplementary materialThe online version of this article (doi:10.1186/s12933-016-0454-x) contains supplementary material, which is available to authorized users.

The impact of nontraditional lipid profiles on left ventricular geometric abnormalities in general Chinese population

“…The degree of contribution of dyslipidemia to LV remodeling has been debated, with evidence both for and against the predictive utility of lipid concentrations on indexes of LV structure [ 8 – 16 ]. Hence, the adoption of nontraditional lipid profiles to estimate altered LV morphology has fostered a growing enthusiasm.…”

“…Reports from observational studies on the possibility of dyslipidemia-induced LV remodeling have been inconsistent [ 8 – 16 ]. Several lines of evidence have demonstrated that low high-density lipoprotein cholesterol (HDL-C) may unfavorably modify LV structure in the setting of elevated LVM or presence of LVH [ 8 – 10 ], whereas others have not [ 11 – 13 ].…”

“…Several lines of evidence have demonstrated that low high-density lipoprotein cholesterol (HDL-C) may unfavorably modify LV structure in the setting of elevated LVM or presence of LVH [ 8 – 10 ], whereas others have not [ 11 – 13 ]. Historically, there were conflicting data as to whether greater total cholesterol (TC) has been implicated in increased LVM [ 15 , 16 ]. It was also plausible that alterations in LV morphology would be related at least in part to the excess of triglyceride (TG) which favors a high LVM-to-volume ratio and LV end-diastolic volume [ 12 ].…”

“…It was also plausible that alterations in LV morphology would be related at least in part to the excess of triglyceride (TG) which favors a high LVM-to-volume ratio and LV end-diastolic volume [ 12 ]. Conversely, lipid derangements, represented as cholesterol remnants and TG, were insufficient to cause an overt increase in LVM and LV wall thickness [ 16 ]. Recent emphasis has been placed in the clinical implications of nontraditional lipid profiles as powerful and independent predictors of cardiovascular disease (CVD) outcomes [ 17 – 21 ].…”

Actions of metformin and statins on lipid and glucose metabolism and possible benefit of combination therapy

“…Remarkable is that T2DM patients receiving statin therapy in combination with increased levels of cholesterol remnants and triglycerides were associated with slight decreased in left ventricular systolic function. Targeting cholesterol remnants in addition to T2DM patients receiving statins might be beneficial on cardiac function [ 151 ]. From a clinical perspective, it was shown that many patients with T2DM and CVD did not receive lipid lowering therapy while their lipid levels were not in the optimal range [ 152 ].…”