Different Lipid Variables Predict Incident Coronary Artery Disease in Patients With Type 1 Diabetes With or Without Diabetic Nephropathy: The FinnDiane Study

Abstract

OBJECTIVETo study the ability of lipid variables to predict incident coronary artery disease (CAD) events in patients with type 1 diabetes at different stages of nephropathy. RESEARCH DESIGN AND METHODSPatients (n = 3,520) with type 1 diabetes and available lipid profiles participating in the Finnish Diabetic Nephropathy Study (FinnDiane) were included in the study. During a follow-up period of 10.2 years (8.6-12.0), 310 patients suffered an incident CAD event. RESULTSApolipoprotein B (ApoB)/ApoA-I ratio was the strongest predictor of CAD in normoalbuminuric patients (hazard ratio 1.43 [95% CI 1.17-1.76] per one SD increase), and ApoB was the strongest in macroalbuminuric patients (1.47 [1.19-1.81]). Similar results were seen when patients were stratified by sex or glycemic control. LDL cholesterol was a poor predictor of CAD in women, normoalbuminuric patients, and patients with HbA 1c below the median (8.3%, 67 mmol/L). The current recommended triglyceride cutoff of 1.7 mmol/L failed to predict CAD in normoalbuminuric patients, whereas the cohort median 0.94 mmol/L predicted incident CAD events. CONCLUSIONSIn patients with type 1 diabetes, the predictive ability of the lipid variables differed substantially depending on the patient's sex, renal status, and glycemic control. In normoalbuminuric patients, the ratios of atherogenic and antiatherogenic lipoproteins and lipids were the strongest predictors of an incident CAD event, whereas in macroalbuminuric patients, no added benefit was gained from the ratios. Current treatment recommendations may need to be revised to capture residual CAD risk in patients with type 1 diabetes.

Risk Factors for Cardiovascular Disease in Type 1 Diabetes

“…The strong association of triglycerides with CVD is consistent with prior studies showing that triglyceride concentration is a particularly strong CVD predictor in diabetes ( 21 ). Further, this association was observed at very low mean values of triglycerides, even in those with subsequent CVD, supporting a recent call for resetting “normal” values in T1DM ( 22 ). These findings suggest that a trial to examine the effects of triglyceride lowering in T1DM should be performed and that the current lack of American Diabetes Association guidelines for treatment of triglycerides ( 23 ) should be reconsidered.…”

The Association of Severe Diabetic Retinopathy With Cardiovascular Outcomes in Long-standing Type 1 Diabetes: A Longitudinal Follow-up

“…Also, CVD data were collected from the national registries instead of the patients' files. However, when data from the national registries were compared with individual patient hospital records previously (41), no classification errors were found, confirming the Finnish registry data to be a reliable source for CVD outcomes identification. In addition, we present data only on SDR.…”

Cardiovascular Risk in Type 1 Diabetes Mellitus

“…In the INTERHEART study the non-fasting apoB/apolipoprotein AI (apoAI) ratio was a better predictor of myocardial infarction than any single lipid or apolipoprotein concentration, or any other combination or ratio of measurements [ 35 ]. In the Finnish Diabetic Nephropathy Study a broad spectrum of lipid variables was evaluated, and the apoB/apoAI ratio was found to be the best predictor for women with normoalbuminuria and acceptable glycaemic control, whereas apoB levels were the best predictor in patients with macroalbuminuria [ 36 ].…”