Journal Article

Lipid variability and risk of microvascular complications in Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial: A post hoc analysis

Hukportie, Daniel Nyarko, Zhou, Rui, Zheng, Jia‐Zhen, Li, Fu‐Rong, Wu, Xian‐Bo, Wu, Xiao‐Xiang, Zou, Meng‐Chen

2022

Overview

Background Greater lipid variability may cause adverse health events among diabetic patients. We aimed to examine the effect of lipid variability on the risk of diabetic microvascular outcomes among type 2 diabetes mellitus patients. Methods We assessed the association between visit‐to‐visit variability (measured by variability independent of mean) in high‐density lipoprotein (HDL) cholesterol, low‐density lipoprotein‐cholesterol (LDL), triglyceride, and remnant cholesterol (RC) measurements among participants involved in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study and the risk of incident microvascular outcomes, including nephropathy, neuropathy, and retinopathy. Cox proportional hazards models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs), adjusted for potential confounders. Results There were 2400, 2470, and 2468 cases of nephropathy, neuropathy, and retinopathy during a follow‐up period of 22 600, 21 542, and 26 701 person‐years, respectively. Higher levels of HDL, triglyceride, and RC variability were associated with an increased risk of incident nephropathy and neuropathy. Compared with the lowest quartile, the fully adjusted HRs (95% CI) for the highest quartile of HDL, triglyceride, and RC variability for nephropathy risk were 1.57 (1.22, 2.01), 1.50 (1.18, 1.92), and 1.40 (1.09, 1.80), respectively; and for neuropathy, the corresponding risks were 1.36 (1.05, 1.75), 1.47 (1.14, 1.91), and 1.35 (1.04, 1.74), respectively. Null association was observed between LDL variability and all microvascular complications. Additionally, all associations of variability in the other lipids with retinopathy risk were null. Conclusion Among individuals with type 2 diabetes mellitus, HDL, triglyceride, and RC variability were associated with increased risks of nephropathy and neuropathy but not retinopathy. Trial registration: ClinicalTrials.gov., no. NCT00000620. 摘要 背景 较大的血脂变异性可能会导致糖尿病患者的不良健康事件。我们旨在2型糖尿病(T2DM)患者中研究血脂变异性对糖尿病微血管结果风险的影响。 方法 我们评估了ACCORD研究参与者在高密度脂蛋白胆固醇(HDL), 低密度脂蛋白胆固醇(LDL), 甘油三酯和残余胆固醇(RC)测量中的随访间变异性(通过独立于平均值的变异性来衡量)与发生微血管病变(包括神经病变, 肾病和视网膜病变)的风险之间的关系。使用COX比例风险模型估计危险比(HR)和95%可信区间(CI), 并对潜在混杂因素进行了校正。 结果 在22600人‐年, 21542人‐年和26701人‐年的随访期内, 分别有2400例肾病, 2470例神经病变和2468例视网膜病变。HDL, 甘油三酯和RC变异性越高, 发生肾病和神经病变的风险就越高。与最低四分位数相比, 高密度脂蛋白, 甘油三酯和RC变异性对肾病风险的完全校正后的HR(95%CI)分别为1.57(1.22, 2.01), 1.50(1.18, 1.92)和1.40(1.09, 1.80)；对于神经病变, 相应的风险分别为1.36(1.05, 1.75), 1.47(1.14, 1.91)和1.35(1.04, 1.74)。在LDL变异性和所有微血管并发症之间无明显关联。此外, 其他血脂的变异性与视网膜病变风险之间无明显关联。 结论 在T2DM患者中, HDL, 甘油三酯和RC变异性与肾病和神经病变的风险增加有关, 但与视网膜病变无关。 HighlightsAssociation of lipid variability with diabetic microvascular complications.

• Publisher: Wiley Publishing Asia Pty Ltd,John Wiley & Sons, Inc
• Subject: Cardiovascular disease / Cholesterol / Diabetes / Disease prevention / Editor's Recommendation / Health risks / High density lipoprotein / Lipids / low‐density lipoprotein / microvascular complications / remnant cholesterol / triglyceride / 低密度脂蛋白 / 微血管并发症 / 残余胆固醇 / 甘油三酯 / 高密度脂蛋白